/ en Sat, 14 Jun 2025 13:35:50 -0500 Wed, 11 Jun 25 14:07:56 -0500 <div class="container"><div class="row"><div class="col-md-8"><p>As the next step in the budget reconciliation process, the Senate has taken up the House-passed budget reconciliation bill (H.R. 1), and it is considering further cuts and changes to Medicaid and other health care programs. The House version of the bill contains <a href="/advisory/2025-05-22-aha-summary-one-big-beautiful-bill-acts-provisions-impacting-hospitals-and-health-systems" title="House version of the bill">provisions</a> that could lead to millions of people losing Medicaid coverage.</p><p>The Senate is currently reviewing H.R. 1, and draft text from the Senate Finance Committee, which has jurisdiction over taxes and Medicaid, could come as soon as this week. <strong>See our </strong><a href="/action-alert/2025-06-08-act-now-ask-your-senators-protect-medicaid-payment-rates-reconciliation-package" title="June 8 Action Alert"><strong>June 8 Action Alert</strong></a><strong> for more information about proposals under consideration related to state-directed payments and provider taxes, and our </strong><a href="/action-alert/2025-06-05-act-now-ask-your-senators-protect-medicaid-and-access-care"><strong>June 5 Action Alert</strong></a><strong> for additional AHA resources on Medicaid and other programs at risk.</strong></p><h2>REGISTER FOR JUNE 17 ADVOCACY DAY IN DC OR PARTICIPATE VIRTUALLY</h2><p>AHA President and CEO Rick Pollack, Executive Vice President Stacey Hughes and other AHA leaders will provide a briefing June 17 on the current congressional landscape and share key messages for leaders to send to legislators on Capitol Hill. You can still register to attend <a href="https://forms.office.com/pages/responsepage.aspx?id=QJMRube-Xk6EsjzBj3s2pnUzMzymJWtHjxrQd2BoFRpUNDNVUkdGWjYyRlJJTUNUVU8wWjVBNTRNWC4u&route=shorturl" title="Registration Page">in person</a>.</p><p><strong>If you cannot make it to Washington, D.C., you can watch the briefing online beginning at 10 a.m. ET. Please register for the </strong><a href="https://aha-advocacy.ispresenting.live/register" title="Registration Page for Virtual attendance"><strong>virtual session</strong></a><strong>. You must register in advance to participate in the briefing. This event is for AHA members only.</strong></p><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="Register for June 17 AHA Advocacy Day"><img src="/sites/default/files/2025-06/cover-register-for-june-17-aha-advocacy-day-bulletin-6-11-2025.png" data-entity-uuid data-entity-type="file" alt="Special Bulletin: Register for June 17 AHA Advocacy DayCover" width="NaN" height="NaN"></a></div></div></div> Wed, 11 Jun 2025 14:07:56 -0500 Advocacy & Public Policy /news/perspective/2025-05-30-reconciliation-bill-shifts-senate-we-must-speak-protect-medicaid-and-access-care <p>After approval in the House last week by a one vote margin, the One Big Beautiful Bill Act — a sweeping package that would enact many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction, including significant changes and cuts to Medicaid and other health care programs — now moves to the Senate.</p><p>House Speaker Mike Johnson compared the bill’s difficult journey through the House to “crossing over the Grand Canyon on a piece of dental floss,” and he has urged the Senate “not to meddle with it too much,” as changes will need to come back to the House for final passage.</p><p>However, the reconciliation package’s move to the Senate really is starting over in many respects as we expect the chamber to consider substantial revisions to the package. Even President Trump said, “I want the Senate and the senators to make the changes they want. I think they are going to have changes. Some will be minor, some will be fairly significant.”</p><p><strong>The bottom line: At this point, nothing is settled, and we still have opportunities to influence the discussion in the Senate and the legislative package they will consider. </strong></p><p><strong>Concerns with Current Bill. </strong>As noted in our <a href="/news/headline/2025-05-22-house-passes-reconciliation-bill-significant-impacts-medicaid-health-insurance-marketplaces" title="Concerns with the current bill reaction">reaction</a> to last week’s vote, we are concerned about the harmful Medicaid and Health Insurance Marketplace provisions currently included in the bill. The sheer magnitude of the level of reductions to the Medicaid program alone — estimated to decimate federal support by more than $700 billion over 10 years — will impact all patients, not just Medicaid beneficiaries, in every community across the nation.</p><p>Hospitals, especially in rural and underserved areas, will be forced to make difficult decisions about whether they will have to reduce services, reduce staff and potentially consider closing their doors. Other impacts could include longer waiting times to receive care, more crowded emergency departments, and hospitals not being able to invest in technology and innovations for clinical care.</p><p>In particular, the Medicaid legislative proposals severely restrict the use of legitimate state funding resources and supplemental payment programs, including provider taxes and state directed payments, under the guise of eliminating waste, fraud and abuse. We reject this notion as these critical, legitimate and well-established Medicaid financing programs are essential to offset decades of chronic underpayments of the cost of care provided to Medicaid patients.</p><p>We will be urging the Senate to make changes to address these and other issues we have with the bill. More details about the bill’s provisions and AHA’s concerns are included in our recent <a href="/advisory/2025-05-22-aha-summary-one-big-beautiful-bill-acts-provisions-impacting-hospitals-and-health-systems" title="Legislative Advisory expressing issues with the current bill.">Legislative Advisory</a> and <a href="/special-bulletin/2025-05-22-house-passes-reconciliation-bill-significant-policy-changes-and-reductions-medicaid-other-health" title="Special Bulletin expressing concerns with the current bill.">Special Bulletin</a>.</p><p><strong>Senate Dynamics and Process. </strong>When the Senate returns to Washington next week and begins to consider the One Big Beautiful Bill Act, it likely will not conduct traditional committee markups, leaving most of the Senate language to be developed by Senate Republican leadership and staff, as well as committee members and staff. </p><p>At the same time, Senate Majority Leader John Thune will have to navigate divisions among Republican senators on what changes to make to the bill. For example, fiscal conservatives Sens. Ron Johnson, R-Wis., and Rand Paul, R-Ky., have already stated their refusal to vote for the legislation unless deeper spending cuts are made. Meanwhile, moderates, including Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, have expressed concerns about Medicaid changes, while Sens. Josh Hawley, R-Mo., and Jim Justice, R-W.Va., have voiced apprehension about the Medicaid provider tax changes. </p><p><strong>Making Our Voices Heard. </strong>With the Senate aiming to pass its bill before the July 4 recess, the next few weeks will be critical to help shape changes to the Senate bill. The AHA will host an Advocacy Day briefing in Washington, D.C., on June 17 to provide the latest updates on the reconciliation bill before hospital and health system leaders meet with their lawmakers on Capitol Hill. Please visit our <a href="/advocacy/action-center" title="AHA Action Center">Action Center</a> for the latest updates and resources.</p><p>In addition, the AHA next week is running digital advertising inside the Beltway urging Congress to protect Medicaid and access to care. At the same time, the <a href="https://strengthenhealthcare.org/" title="Coalition to Strengthen America's Healthcare">Coalition to Strengthen America’s Healthcare</a>, of which the AHA is a founding member, continues to run TV and digital advertisements, including its <a href="https://strengthenhealthcare.org/coalition-to-strengthen-americas-healthcare-new-faces-of-medicaid-ad-mom/" title="Coalition to Strengthen America's Health Care latest ad ">latest ad</a> in its national Faces of Medicaid campaign, calling attention to the devastating effects that Medicaid cuts would have on millions of seniors and their families.</p><p>While we provide the air cover, it’s so important for you to share with your senators the negative consequences some of the proposals would have on the patients and communities you serve.</p><p>Nothing is more powerful with lawmakers than your voice — and the voices of your team members, trustees, patients and community members. You live, work and, most importantly, vote in their states and districts. You have their attention and can explain to them the impact policy proposals would have for their constituents and your ability to provide care.</p><p>With so much at stake, it is vital that we continue speaking with one voice to protect the blue and white “H” that is a beacon of health, healing and hope in every community across the nation.</p> Fri, 30 May 2025 08:35:47 -0500 Advocacy & Public Policy <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives May 22 passed the One Big Beautiful Bill Act (H.R. 1), a sweeping package that would enact many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill, which Republicans are attempting to pass through reconciliation — a budget tool that gives Congress a fast-track mechanism to avoid the Senate filibuster and pass legislation with a simple majority — includes significant policy changes to Medicaid and the Health Insurance Marketplaces that will jeopardize access to care for communities.</p><p>The action now moves to the Senate, which is expected to make changes to the bill. As the Senate considers the bill in the coming weeks, it is critical for hospital and health system leaders to stay informed and engaged to protect Medicaid and other health care programs from devastating policy changes.</p><p><strong>Hospital and health system leaders can </strong><a href="https://forms.office.com/pages/responsepage.aspx?id=QJMRube-Xk6EsjzBj3s2pnUzMzymJWtHjxrQd2BoFRpUNDNVUkdGWjYyRlJJTUNUVU8wWjVBNTRNWC4u&route=shorturl"><strong>register</strong></a><strong> for a June 17 AHA Advocacy Day event in Washington, D.C.</strong> AHA President and CEO Rick Pollack, Executive Vice President Stacey Hughes, and other AHA leaders will provide a briefing on the current congressional landscape and share key messages to share with representatives and senators on Capitol Hill. <strong>This event is for AHA members only.</strong></p><p><strong>Watch for an Action Alert from the AHA soon detailing key messages and new resources to use in your advocacy efforts.</strong></p><h2>Medicaid Resources</h2><p>Visit the <a href="/advocacy-issues">AHA Medicaid Issues</a> page for a complete list of tools and resources including:</p><ul><li><a href="/advocacy/advocacy-issues/medicaid">Fact Sheets and Infographics</a>. The AHA has developed a series of fact sheets and infographics to inform your advocacy efforts.</li><li><a href="https://drive.google.com/drive/folders/1b2YQHHn4dAfbSe_Gxy-QsxY7Uwo2Qtlq">Digital Toolkit</a>. Use this toolkit to engage stakeholders, such as your hospital or health system teams and community leaders, in joining the fight to protect Medicaid.</li><li><a href="https://youtu.be/wWHMwW8CcWk?si=vGLEa9fyODr2WA6l">Medicaid Made Simple Video</a>. This video explains how vital Medicaid is to your communities.</li></ul><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. If you have further questions, please contact the AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/register-for-june-17-aha-advocacy-day-in-washington-dc-bulletin-5-29-25.pdf"><img src="/sites/default/files/2025-05/cover-register-for-june-17-aha-advocacy-day-in-washington-dc-bulletin-5-29-25.png" data-entity-uuid data-entity-type="file" alt="Special Bulletin: Register for June 17 AHA Advocacy Day in Washington, D.C. Cover" width="NaN" height="NaN"></a></div></div></div> Thu, 29 May 2025 08:36:03 -0500 Advocacy & Public Policy /fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p>For the past decade, the health care field has experienced a sharp increase in workplace violence. Several factors have imposed significant stress on the entire health care system, and in some instances, patients, visitors and family members have attacked health care staff and jeopardized our workforce’s ability to provide care. This rise in workplace violence has shown no indication of subsiding. Hospitals, health systems and providers support the enactment of a federal law that would protect health care workers from violence, just as current federal law protects airline and airport workers.</p><h2>Background</h2><p>Hospitals and health systems have long had robust protocols to detect, deter and respond to violence against their team members. However, violence against hospital employees continues to increase. </p><p>Day after day, the media reports on patients or family members assaulting hospital staff, sometimes with deadly consequences. For example, a Kentucky nurse was choked, thrown to the ground, and hit by a patient who later told police she was mad because “staff was taking too long to discharge her from the hospital.”<sup>1</sup> Last year, a Florida physician sustained a concussion, brain contusion and two broken ribs after an alleged attack by a patient’s relative.<sup>2</sup> </p><p>Data supports these news accounts. A Press Ganey survey found that on average, two nurses are assaulted every hour in the U.S., and a 2024 American College of Emergency Physicians survey found that 9 out of 10 respondents reported having been attacked or threatened in the past year. </p><p>Workplace violence has severe consequences for the entire health care system. Not only do these assaults cause physical and psychological injury for health care workers, but they make it more difficult for nurses, physicians and other clinical staff to provide quality patient care. Nurses and physicians cannot provide attentive care when they are afraid for their safety, distracted by disruptive patients and family members, or traumatized from prior violent interactions. </p><p>In addition, violent interactions at health care facilities tie up valuable resources and can delay urgently needed care for other patients. Studies show that workplace violence reduces patient satisfaction and employee productivity and increases the potential for adverse medical events.</p><h2>AHA Take</h2><p>Despite the incidence of workplace violence and its harmful effects on our health care system, no federal law protects hospital workers from workplace assault. By contrast, Congress responded to increases in violent behavior on commercial aircraft and in airports by enacting a federal law criminalizing attacks against those employees. Vigorous enforcement of these federal laws helps to create a safer traveling environment, deters violent behavior and ensures that offenders are appropriately punished. Our nation’s health care workers, who tirelessly treat patients while facing increased violence, deserve the same legal protections as airline workers. <span><strong>Congress should enact the bipartisan Save Healthcare Workers Act (H.R. 3178/S. 1600), which provides protections similar to those in current law for flight crews, flight attendants and airport workers. </strong></span></p><p>The Save Healthcare Workers Act would make it a federal crime to knowingly assault a hospital worker on the job and establish fines, imprisonment, or both for these offenses. The legislation creates an affirmative defense if the assault results from the perpetrator’s physical, mental or intellectual disability; in other words, if a patient, family member or visitor assaults a health care worker because of such a disability, that person could not be prosecuted.<br>__________<br><small class="sm"><sup>1</sup> Mike Stunson, Patient chokes nurse because her discharge was taking too long, Kentucky cops say, Lexington Herald Leader (April 28, 2025)</small><br><small class="sm"><sup>2</sup> Mariah Taylor, Florida physician injured after alleged attack by patient’s son, Becker’s Hospital Review (Oct.16, 2024)</small><br><a class="ck-anchor" id="https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-injured-after-alleged-attack-by-patients-son/" href="https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-injured-after-alleged-attack-by-patients-son/"><small class="sm">https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-injured-after-alleged-attack-by-patients-son/</small></a><small class="sm"> </small></p><p> </p></div><div class="col-md-4"><p><a href="/system/files/media/file/2022/09/Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response.pdf" target="_blank" title="Click here to download the Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response PDF."><img src="/sites/default/files/2025-05/cover-Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response-r-5-28-2025.png" data-entity-uuid data-entity-type="file" alt="Cover: Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response May 28, 2025" width="NaN" height="NaN"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/09/Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response.pdf" target="_blank" title="Click here to download the Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response PDF.">Download the PDF</a></div></div></div></div> Wed, 28 May 2025 14:49:00 -0500 Advocacy & Public Policy <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives May 22 passed by a 215-214 vote H.R. 1, the <a href="https://rules.house.gov/sites/evo-subsites/rules.house.gov/files/documents/rcp_119-3_final.pdf" target="_blank">One Big Beautiful Bill Act</a>, a sweeping package that would enact many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill, which Republicans are attempting to pass through reconciliation, includes significant policy changes to Medicaid and the Health Insurance Marketplaces. See AHA’s <a href="/press-releases/2025-05-21-aha-statement-house-reconciliation-legislation">statement</a> from AHA President and CEO Rick Pollack, sent late yesterday to congressional offices prior to the House vote. The action now moves to the Senate, which is expected to make changes to the bill.</p><p>Before House passage, the bill was <a href="https://amendments-rules.house.gov/amendments/RCP_119-3_Managers_xml (002)250521201648156.pdf" target="_blank">amended</a>, including several changes that were made on May 21. The following is a summary of provisions included in the bill that affect hospitals and health systems, as well as some resources from the Congressional Budget Office regarding the impact of the bill.</p><h2>Congressional Budget Office Resources</h2><ul><li><a href="https://www.cbo.gov/publication/61420" target="_blank">Estimated Budget Effects</a></li><li><a href="https://www.cbo.gov/system/files/2025-05/61423-PAYGO.pdf" target="_blank">Potential Statutory Pay-As-You-Go Effects</a></li><li><a href="https://www.cbo.gov/system/files/2025-05/61422-Reconciliation-Distributional-Analysis.pdf" target="_blank">Preliminary Analysis of the Distributional Effects</a></li></ul><h2>AHA Summary of Provisions Impacting Hospitals and Health Systems</h2><h3>Title III — Committee on Education and Workforce</h3><h4>Section 30011: Loan limits</h4><p>Terminates the Grad PLUS loan program effective July 1, 2026, and would prohibit any new Grad PLUS loans during the 2026-2027 school year, including a three-year exception for students who were enrolled in a program of study as of June 30, 2026, and had previously received a Grad PLUS loan.</p><p>Amends the maximum annual loan limit for unsubsidized loans disbursed to graduate students to $100,000 and for professional programs, including medical school, to $150,000.</p><h4>Section 30024: Public service loan forgiveness</h4><p>Clarifies that payments made by new borrowers on or after July 1, 2025, who are serving in a medical or dental residency would not count as qualifying payments toward public service loan forgiveness.</p><h3>Title IV — Energy and Commerce</h3><h4>Subtitle D — Health</h4><h4>SUBPART A: REDUCING FRAUD AND IMPROVING ENROLLMENT PROCESSES</h4><h4>Section 44101: Moratorium on implementation of rule relating to eligibility and enrollment in Medicare Savings Programs (Effective from enactment through Jan. 1, 2035)</h4><p>Prohibits the Department of Health and Human Services (HHS) Secretary from implementing, administering or enforcing the Medicare Savings Program (MSP) rule for 10 years. This would rollback requirements that states 1) automatically enroll certain Supplemental Security Income recipients in the qualified Medicare beneficiary eligibility group of the MSP program, 2) use data from the low-income subsidy program as an application for MSPs and align the family size definitions between the MSP and Low Income Subsidy programs, and 3) accept self-attestation for certain types of income and resources.</p><h4>Section 44102: Moratorium on implementation of rule relating to eligibility and enrollment for Medicaid, CHIP and the Basic Health Program (Effective from enactment through Jan. 1, 2035)</h4><p>Prohibits the HHS secretary from implementing, administering or enforcing the eligibility and enrollment rule for 10 years. This would limit states’ ability to use other data sources (such as payroll or state vital statistics data) to determine an individual’s eligibility for Medicaid and limit states’ use of prepopulated renewal forms. It would also allow states to impose annual and/or lifetime limits on Children’s Health Insurance Program (CHIP) benefits and to disenroll CHIP beneficiaries for failure to pay premiums or enrollment fees.  </p><h4>Section 44103: Ensuring appropriate address verification under the Medicaid and CHIP programs</h4><p>Requires regular (no less than once each month) enrollee address verification and is intended to prevent individuals from enrolling in two state Medicaid or CHIP programs simultaneously. This section would require state Medicaid agencies to establish a process to collect address information for Medicaid enrollees and report certain identifying information to the HHS secretary by Jan. 1, 2027. The secretary would be required to establish a system that would identify when an individual is enrolled in two state programs simultaneously, determine in which state the individual resides, and disenroll the individual from other state Medicaid or CHIP programs. The section appropriates $10 million for fiscal year (FY) 2026 to establish a system and $20 million for FY 2029 to maintain that system.</p><h4>Section 44104: Modifying certain state requirements for ensuring deceased individuals do not remain enrolled (Effective Jan. 1, 2028)</h4><p>Requires states to review the Social Security Administration’s Death Master File to determine whether any enrollees are deceased. If a beneficiary is disenrolled in error, the state must re-enroll them retroactively to the date of disenrollment.</p><h4>Section 44105: Medicaid provider screening requirements (Effective Jan. 1, 2028)</h4><p>Requires states to regularly (no less frequently than monthly) check provider eligibility to determine whether HHS or the state has terminated the provider’s participation.</p><h4>Section 44106: Additional Medicaid provider screening requirements (Effective Jan. 1, 2028)</h4><p>Requires states to regularly (no less than quarterly) check the Death Master File to determine whether providers are deceased.</p><h4>Section 44107: Removing good faith waiver for payment reduction related to certain erroneous excess payments under Medicaid (Effective FY 2030)</h4><p>Limits the authority of the HHS secretary to waive payment reductions and requires HHS to reduce federal funding to states derived from states making erroneous excess payments for ineligible individuals or services. </p><h4>Section 44108: Increasing frequency of eligibility redeterminations for certain individuals (Effective Dec. 31, 2026)</h4><p>Requires states to redetermine eligibility once every six months for beneficiaries enrolled through the Medicaid expansion eligibility pathway.</p><h4>Section 44109: Revising home equity limit for determining eligibility for long-term care services under the Medicaid program (Effective Jan. 1, 2028)</h4><p>Revises the permissible home equity interest limit to $1,000,000 to determine allowable assets for nursing facility services and long-term care. Asset disregards are prohibited. </p><h4>Section 44110: Prohibiting federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality or satisfactory immigration status (Effective Oct. 1, 2026)</h4><p>Prohibits federal financial participation for Medicaid and CHIP enrollees in a reasonable opportunity period unless the individual successfully verifies their citizenship or immigration status. It is optional for states to provide coverage during the verification period.</p><h4>Section 44111: Reducing expansion Federal Medical Assistance Percentage for certain states providing payments for health care furnished to certain individuals (Effective Oct. 1, 2027)</h4><p>Reduces the Federal Medical Assistance Percentage (FMAP) to 80% for the expansion population in states that use state funds to cover aliens who are not qualified aliens or lawfully residing pregnant women and children (i.e., undocumented immigrants and certain lawfully residing adults). “Coverage” is not limited to Medicaid and may include other programs established by the state to offer financial assistance to purchase health insurance coverage or to provide comprehensive health benefits coverage.</p><h3>SUBPART B: PREVENTING WASTEFUL SPENDING</h3><h4>Section 44121: Moratorium on Minimum Staffing Rule for long-term care facilities (Effective from enactment through Jan. 1, 2035)</h4><p>Prohibits HHS from implementing the Minimum Staffing Standards for long-term care facilities and the Medicaid Institutional Payment Transparency Reporting regulation for 10 years.</p><h4>Section 44122: Modifying retroactive under the Medicaid and CHIP programs (Effective Dec. 31, 2026)</h4><p>Limits the timeframe for retroactive Medicaid and CHIP eligibility to 30 days prior to the application date, as opposed to the current 90-day period.</p><h4>Section 44123: Ensuring accurate payments to pharmacies under Medicaid (Effective first day of the first quarter that begins six months after enactment)</h4><p>Expands transparency requirements regarding Medicaid payments to pharmacies for covered outpatient drugs. The secretary is required to conduct a survey to determine, and make publicly available, national average drug acquisition prices and cost benchmarks. Monetary penalties may be imposed on retail community pharmacies or non-retail pharmacies for failing to comply with a survey request, providing false information or otherwise failing to comply with requirements.</p><h4>Section 44124: Preventing the use of abusive spread pricing in Medicaid (Effective for contracts that begin 18 months after the date of enactment)</h4><p>This section requires that payment for drugs and related administrative services is based on a transparent prescription drug pass-through pricing model and prohibits any form of spread pricing. Payment made by the entity or pharmacy benefit manager (PBM) is limited to ingredient cost and a professional dispensing fee. The payment must be passed through in its entirety by the entity or PBM to the pharmacy or provider dispensing the drug.</p><h4>Section 44125: Prohibiting federal Medicaid and CHIP funding for gender transition procedures</h4><p>Prohibits states from receiving federal funds for specified gender transition procedures. This does not apply to certain services provided by a health care provider with parental/legal guardian consent, including puberty suppression, blocking prescription drugs to normalize puberty or an individual experiencing precocious puberty, and certain medically necessary procedures.</p><h4>Section 44126: Federal payment to prohibited entities (Effective from enactment for 10 years)</h4><p>Prohibits states from receiving federal matching funds for services rendered by providers that provide abortions (other than Hyde Amendment exceptions) and receive more than $1 million in Medicaid payments in 2024. This applies to not-for-profit, essential community providers primarily engaged in family planning services, reproductive health and related medical care. This provision would apply for 10 years, beginning on the date of enactment.</p><h3>SUBPART C: STOPPING ABUSIVE FINANCING PRACTICES</h3><h4>Section 44131: Sunsetting eligibility for increased FMAP for expansion states (Effective Jan. 1, 2026)</h4><p>Repeals the ability for states that have not yet expanded Medicaid to receive 5% enhanced FMAP funds should they later choose to expand.</p><h4>Section 44132: Moratorium on new or increased provider taxes (Effective from enactment)</h4><p>Disallows federal matching funds for state provider taxes imposed after the date of enactment or any provider taxes that were increased (in amount or rate) after the date of enactment. The draft legislation also includes a provision that prohibits states from increasing the tax base by expanding items or services, or expanding the tax base to include providers that were previously not included. This would effectively cap provider taxes at the amount in place on the date of enactment.</p><h4>Section 44133: Revising the payment limit for certain directed payments (Effective from enactment)</h4><p>Limits state-directed payments (SDPs) to no more than 110% of the published Medicare payment rate for non-expansion states and 100% of the published Medicare payment rate for expansion states, except for previously approved SDPs or preprints submitted to the HHS secretary prior to the date of enactment. However, states with SDPs in place could not increase the amount and would be required to submit grandfathered SDP preprints for CMS approval when seeking renewal. In the absence of a published Medicare rate, an equivalent rate could be used. If a state expands Medicaid after the date of enactment, SDPs would be subject to the 100% Medicare upper payment limit, including preprints for which prior approval was made before the state expanded Medicaid.  </p><h4>Section 44134: Requirements regarding waiver of uniform tax requirement for Medicaid provider tax</h4><p>Modifies the requirements regarding uniformity of provider taxes and, specifically, whether a state’s tax is considered “generally redistributive.” Under the draft legislation, a tax is not considered generally redistributive if:</p><ol type="a"><li>Lower volume Medicaid health care entities are taxed at a lower rate than higher volume Medicaid health care entities.</li><li>High Medicaid volume health care entities are taxed more heavily than non-Medicaid health care entities.</li><li>The tax establishes any target or exclusion related to a health care entity’s Medicaid participation status.</li></ol><h4>Section 44135: Requiring budget neutrality for Medicaid demonstration projects under Section 1115</h4><p>Codifies CMS practice of requiring that Section 1115 waivers not increase federal spending compared to what a state would have spent without the waiver. It also requires the secretary to specify a methodology for using waiver savings for subsequent approvals.</p><h3>SUBPART D: INCREASING PERSONAL ACCOUNTABILITY</h3><h4>Section 44141: Community engagement (work) requirements (Effective December 31, 2026)</h4><p>Establishes work requirements for certain Medicaid beneficiaries. Beginning Dec. 31, 2026, or earlier at the option of the state, states are required to establish work requirements for non-exempt expansion adults aged 19-64. Individuals must work or engage in qualifying activities (e.g., community service, educational programs, job training) for no less than 80 hours/month. Mandatory exceptions include individuals under the age of 19, pregnant or post-partum women, individuals enrolled in Medicare Part A or Part B, and institutionalized individuals. Optional exceptions for short-term hardship events include individuals receiving inpatient hospital services, nursing facility services or inpatient psychiatric services; individuals in disaster zones; and individuals in areas with high unemployment. Compliance is verified during the initial eligibility determination, as well as part of subsequent eligibility redetermination, or more frequently as determined by the state. States may use data sources like payroll data to verify compliance. If the state is unable to verify that the individual has met the community engagement requirements, the individual will have 30 days to demonstrate compliance before they are disenrolled. States must determine whether an individual would qualify for Medicaid under other eligibility pathways before disenrolling. Grants totaling $100 million are provided in FY 2026 for system development. The amended section changes a requirement that the secretary promulgate rules regarding the implementation and instead directs the secretary to issue guidance not later than Dec. 31, 2025.</p><h4>Section 44142: Modifying cost-sharing requirements for certain expansion individuals under the Medicaid program (Effective Oct. 1, 2028)</h4><p>Requires states to impose cost-sharing requirements at an amount greater than $0 and not exceeding $35 on Medicaid expansion enrollees, as determined by the state. Total cost sharing may not exceed 5% of family income. Cost-sharing requirements cannot be imposed on pregnancy-related services, primary care, mental health or substance use disorder services. States may allow providers to require payment as a condition of providing services. Providers may waive cost-sharing requirements on a case-by-case basis. This section also prohibits states from requiring Medicaid expansion enrollees to pay a premium, enrollment fee, or other such charge.</p><h3>Other Provisions Related to Medicaid</h3><h4>Section 44302: Streamlined enrollment process for eligible out-of-state providers under Medicaid and CHIP</h4><p>Streamlines enrollment requirements for eligible out-of-state providers. Eligible out-of-state providers are those who are determined by the secretary or another state Medicaid program to have limited risk of fraud, waste and abuse and have not been excluded from participation in a state Medicaid program or other federal health program.</p><h4>Section 44303: Delaying disproportionate share hospital reductions</h4><p>Delays the Medicaid disproportionate share hospital (DSH) reductions to FYs 2029 through 2031. Under current law, federal allotments for Medicaid DSH would be reduced by $8 billion for FYs 2026 through 2028. The section also extends Tennessee’s DSH allotment through 2028.</p><h3>Other Provisions Unrelated to Medicaid</h3><h4>Section 44304: Modifying update to the conversion factor under the physician fee schedule under the Medicare program</h4><p>Creates a single conversion factor for Physician Fee Schedule services under the Medicare program starting in 2026 (as opposed to the two distinct ones in place today — one for physicians participating in alternative payment models and another for those who are not). For 2026, the update to the single conversion factor would be 75% of the Medicare Economic Index (MEI), and, for 2027, it would be 10% of the MEI. This provision would not be retroactive.</p><h4>Section 44201: Addressing waste, fraud and abuse in the Accountable Care Act exchanges</h4><p>Codifies most of the proposed policies in the 2025 Marketplace Integrity rule, including:</p><ul><li>Shortening the Health Insurance Marketplace open enrollment period.</li><li>Removing the low-income special enrollment period.</li><li>Changes to the premium adjustment percentage methodology.</li><li>Allowing insurers to require that enrollees pay past-due premiums before renewing coverage.</li><li>Disallowing DACA recipients from receiving premium tax credits or cost-sharing reductions.</li><li>Prohibiting gender-affirming care as an essential health benefit.</li><li>Greater eligibility verification processes.</li></ul><p>The draft legislation does not include the proposal to improve transparency of agency, broker and web-broker behavior, and varies in its language regarding the de minimus range, which impacts the value of coverage within each metal tier.</p><h4>Section 44202: Funding cost-sharing reduction payments</h4><p>Restores federal funding for the cost-sharing reduction (CSR) payments, which reduce costs for low-income marketplace enrollees. The federal government stopped funding these payments beginning in the 2018 plan year, as Congress did not appropriate the funds. To address the lack of funding, insurers increased the cost of silver plan premiums in a practice known as "silver-loading." This increased the cost of premium tax credits, which are based on the second-lowest cost silver plan premium. By funding the CSR payments, insurers will no longer need to silver load, which will lower the value of the premium tax credits and generate savings for the federal government.</p><h3>Title XI — Committee on Ways and Means, ‘‘The One, Big, Beautiful Bill’’</h3><h4>SUBPART A: MAKE AMERICAN FAMILIES AND WORKERS THRIVE AGAIN</h4><h4>Section 110112: Reinstatement of partial deduction for charitable contributions of individuals who do not elect to itemize</h4><p>Creates a temporary deduction for non-itemizing taxpayers up to $150 for single filers ($300 for married filing jointly) for charitable cash contributions for tax years 2025 through 2028. The charitable contribution must be made to a qualified charity and cannot be made to Donor-Advised Funds or supporting organizations.</p><h4>Sections 110201-110203: Custom Health Option and Individual Care Expense (CHOICE) arrangements</h4><p>Regulations finalized in 2019 created “individual coverage health reimbursement arrangements (ICHRAs),” which allow employers to offer their employees financial support to purchase health insurance on the individual markets, in addition to other medical expenses. This bill would codify those regulations, rename ICHRAs as Custom Health Option and Individual Care Expense (CHOICE) arrangements, and remove some of the administrative barriers to implementation. In addition, the bill would create a tax credit for businesses with fewer than 50 employees to implement CHOICE arrangements by offering a $100 per employee tax credit in the first year of implementation and a $50 per employee tax credit in the second year.</p><h4>Sections 110204, 110206, 110208-110213: Health savings account provisions</h4><p>Health savings accounts (HSAs) are tax-advantaged savings accounts for high-deductible health plan (HDHP) enrollees. There are strict regulations around who can utilize HSAs and how their funds can be used. This bill would expand HSA access to individuals enrolled in Medicare Part A if they are also still enrolled in their private HDHP, and to individuals enrolled in bronze or catastrophic health plans in the individual market. The bill would also create more flexibility in how individuals contribute, for example, by allowing eligible individuals to contribute even if their spouse has a flexible spending arrangement, and what services can be covered by HSA funds. Finally, the bill would increase HSA contribution limits for individuals with annual income that is less than $75,000 individually or $150,000 for a family.</p><h4>Section 110205: Treatment of direct primary care service arrangements</h4><p>Excludes direct primary care (DPC) service arrangements from classification as a health plan for the purposes of HSA eligibility so long as the primary care arrangement is for only primary care services, the individual pays a fixed monthly fee, and that amount doesn’t exceed $150 for an individual (twice the amount for coverage of more than one person). Would clarify that anesthesia, prescription drugs and lab services would not qualify as DPC services. Would allow for DPC services to be qualified medical expenses by excluding DPC arrangements from the definition of “health insurance” for which HSAs could not be utilized. Would also provide for cost-of-living adjustments for DPC arrangements. In general, this provides additional flexibility for HSAs to be used for DPC arrangements, which may increase beneficiary enrollment in these types of plans.</p><h4>SUBPART B: MAKE RURAL AMERICA AND MAIN STREET GROW AGAIN</h4><h4>Section 111201: Expanding the definition of rural emergency hospital under the Medicare program</h4><p>This provision allows for the conversion to a rural emergency hospital (REH) if state licensure is not currently provided but will be licensed as such within one year of the state providing such licensure. It also allows for a facility located less than 35 miles away from another hospital, critical access hospital (CAH) or REH, to be an REH, provided that annually, the facility must demonstrate more than 50% of the services provided are emergency and observation care for Medicare Part A and B patients. The provision permits eligibility for conversion from CAHs and small rural (<50 beds) hospitals opened between Jan. 1, 2014, and Dec. 26, 2020. Additionally, outpatient prospective payment system plus 5% payment to facilities located less than 35 miles away from another hospital, CAH or REH are disallowed. The provision also disallows a monthly facility payment to facilities located less than 10 miles away from another hospital, CAH or REH.</p><h4>SUBPART C: MAKE AMERICA WIN AGAIN</h4><h4>Section 112003: Termination of qualified commercial clean vehicles credit</h4><p>Eliminates the qualified commercial clean vehicles credit at the end of 2025. Provides an exception for vehicles placed in service before 2033 and under a binding contract entered into before May 2025.</p><h4>Section 112004: Termination of alternative fuel vehicle refueling property credit</h4><p>Eliminates the alternative fuel vehicle refueling property credit at the end of 2025.</p><h4>Section 112009: Restrictions on clean electricity investment credit</h4><p>Restricts the clean electricity investment credit by making zero credit available after Dec. 31, 2028. This provision restricts access to the credit for certain prohibited foreign entities.</p><p>This provision restricts access to the credit for certain prohibited foreign entities. Specifically:</p><ol type="1"><li>No credit is allowed for a facility that commences construction a year after the enactment of this bill that includes any material assistance from a prohibited foreign entity.</li><li>No credit is allowed for taxable years beginning after enactment if the taxpayer is a specified foreign entity.</li><li>No credit is allowed for tax years that begin two years after the date of enactment for foreign influence entities or if the taxpayer makes fixed, determinable, annual or periodic (FDAP) amount payments to a prohibited foreign entity that are more than 5% of total expenditures related to the credit generating activity or 15% in aggregate</li></ol><h4>Section 112015: Phase-out of credit for certain energy property</h4><p>Aligns the expiration of the investment tax credit for geothermal heat pumps with the clean electricity investment tax credit. There is a 20% credit reduction for facilities placed in service in calendar year 2029, a 40% reduction for facilities placed in service in 2030, a 60% reduction for facilities placed in service in 2031 and no credit available after Dec. 31, 2031.</p><p>This provision restricts access to the credit for certain prohibited foreign entities. Specifically:</p><ol type="1"><li>No credit is allowed for taxable years beginning after enactment if the taxpayer is a specified foreign entity.</li><li>No credit is allowed for tax years that begin two years after the date of enactment for a foreign-influenced entity.</li></ol><h4>Section 112019: Excessive employee renumeration from controlled group members and allocation of deduction</h4><p>Applies aggregation rules for the deduction limitation and allocation of deduction applied under Internal Revenue Code (IRC) section 162(m) as it relates to certain excessive employee remuneration.</p><h4>Section 112021: Modification of excise tax on investment income of certain private colleges and universities</h4><p>Amends the current excise tax on net investment income framework for certain private colleges and universities under IRC section 4968 with a tiered system based on an institution’s student-adjusted endowment (see table below). For purposes of calculating an institution's student-adjusted endowment, this section amends such calculation by excluding students who do not meet the requirements under Section 484(a)(5) of the Higher Education Act of 1965. This section also provides an exemption from being considered an applicable educational institution, provided the institution meets certain requirements related to being a qualified religious institution. Additionally, this section includes student loan interest income and certain royalty income to calculate a school’s net investment income.</p><table><thead><tr><th>Student-Adjusted Endowment</th><th>Excise Tax Rate</th></tr></thead><tbody><tr><td>$500,000-$749,999</td><td>1.4% (current rate)</td></tr><tr><td>$750,000-$1,249,999</td><td>7%</td></tr><tr><td>$1,250,000-$1,999,999</td><td>14%</td></tr><tr><td>$2,000,000+</td><td>21%</td></tr></tbody></table><h4>Section 112022: Increase tax rate on net investment income of certain private foundations</h4><p>Amends the current excise tax on net investment income framework for tax-exempt private foundations under IRC section 4940(a) with a tiered system that maintains the current excise tax rate for private foundations with less than $50 million in total assets but applies higher excise tax rates on private foundations reporting $50 million or more in total assets (see table below).</p><table><thead><tr><th>Size of Private Foundation (in assets)</th><th>Excise Tax Rate</th></tr></thead><tbody><tr><td>$0-$49,999,999</td><td>1.39% (current rate)</td></tr><tr><td>$50,000,000-$249,999,999</td><td>2.78%</td></tr><tr><td>$250,000,000-$4,999,999,999</td><td>5%</td></tr><tr><td>$5,000,000,000+</td><td>10%</td></tr></tbody></table><h4>Section 112024: Unrelated business taxable income increased by the amount of certain fringe benefit expenses for which deduction is disallowed</h4><p>Amends IRC section 512 to increase the unrelated business taxable income of a tax-exempt organization by including the amount paid or incurred for any qualified transportation fringe benefit.</p><h4>Section 112025: Name and logo royalties treated as unrelated business taxable income</h4><p>Amends IRC sections 512 and 513 to increase the unrelated business taxable income of a tax-exempt organization by including the income from any sale or licensing by an organization of its name or logo.</p><h4>Section 112026: Exclusion of research income limited to publicly available research</h4><p>Amends IRC section 512 to increase the unrelated business taxable income of a tax-exempt organization by including the income generated from non-public research for an organization whose tax-exempt purpose is to provide publicly available research as unrelated business income.</p><h4>Section 112101: Permitting premium tax credit only for certain individuals</h4><p>Eliminates premium tax credit eligibility for undocumented immigrants and only allows eligibility for Lawful Permanent Residents, certain Cuban immigrants, and individuals living in the U.S. through a Compact of Free Association.</p><h4>Section 112102: Certain aliens treated as ineligible for premium tax credit</h4><p>Prohibits individuals with immigration status granted by asylum (or pending an asylum application), parole, temporary protected status, deferred enforced departure and withholding of removal from receiving premium tax credits.</p><h4>Section 112103: Disallowing premium tax credit during periods of Medicaid ineligibility due to alien status</h4><p>Strikes the loophole that allows undocumented immigrants who report income below 100 percent of the federal poverty level and are in their five-year Medicaid waiting period (due to immigration status) to receive premium tax credits to purchase health insurance on the Exchange.</p><h4>Section 112201: Requiring Exchange verification of eligibility for health plan</h4><p>Prohibits an individual from claiming the premium tax credit if the individual’s eligibility related to income, enrollment and other requirements is not actively verified annually. This would prohibit automatic reenrollment for enrollees receiving premium tax credits by requiring them to actively prove tax credit eligibility each year. Over half of all returning enrollees in 2025 enrolled through automatic reenrollment.</p><h4>Section 112202: Disallowing premium tax credit in case of certain coverage enrolled in during the special enrollment period</h4><p>Prohibits individuals from receiving premium tax credits if they enroll in health coverage on the Exchange through a special enrollment period associated with their income.</p><h4>Section 112203: Eliminating limitation on recapture of advance payment of premium tax credit</h4><p>Removes the repayment limits and requires affected individuals to reimburse the Internal Revenue Service for the full amount of excess tax credit received.</p><h4>Section 112204: Implementing artificial intelligence tools to reduce and recoup improper payments under Medicare</h4><p>Provides $25 million for the HHS secretary to contract with artificial intelligence contractors and data scientists to examine Medicare improper payments and recoup overpayments. Additionally, the secretary is required to report to Congress on progress in decreasing the number of Medicare improper payments.</p><h4>SUBPART D: INCREASE IN DEBT LIMIT</h4><h4>Section 113001: Modification of limitation on the public debt</h4><p>Increases the statutory debt limit by $4 trillion.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p><p><a href="/system/files/media/file/2025/05/Legislative-Advisory-AHA-Summary-of-One-Big-Beautiful-Bill-Acts-Provisions-Impacting-Hospitals-and-Health-Systems.pdf"><span><em><strong>Read the complete Legislative Advisory.</strong></em></span></a></p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/Legislative-Advisory-AHA-Summary-of-One-Big-Beautiful-Bill-Acts-Provisions-Impacting-Hospitals-and-Health-Systems.pdf"><img src="/sites/default/files/inline-images/Page-1-Legislative-Advisory-AHA-Summary-of-One-Big-Beautiful-Bill-Acts-Provisions-Impacting-Hospitals-and-Health-Systems.png" data-entity-uuid="7b4d504a-d7a3-4f38-b807-ac4bd58ba5fb" data-entity-type="file" alt="Legislative Advisory: AHA Summary of One Big Beautiful Bill Act’s Provisions Impacting Hospitals and Health Systems page 1." width="696" height="900"></a></div></div></div> table, th, td { border: 1px solid; } Thu, 22 May 2025 15:08:44 -0500 Advocacy & Public Policy <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives May 22 passed by a 215-214 vote H.R. 1, the <a href="https://rules.house.gov/sites/evo-subsites/rules.house.gov/files/documents/rcp_119-3_final.pdf" target="_blank">One Big Beautiful Bill Act</a>, a sweeping package that would enact many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill, which Republicans are attempting to pass through reconciliation — a <a href="/issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page">budget tool</a> that gives Congress a fast-track mechanism to avoid the Senate filibuster and pass legislation with a simple majority — includes significant policy changes to Medicaid and the Health Insurance Marketplaces that will jeopardize access to care for communities. The action now moves to the Senate, which is expected to make changes to the bill.</p><p>This Special Bulletin includes several updates and resources related to the bill, including:</p><ul><li><strong>Changes Made to the Bill.</strong> The House late yesterday made several <a href="https://amendments-rules.house.gov/amendments/RCP_119-3_Managers_xml (002)250521201648156.pdf?_gl=1*1jziwmj*_ga*MTIyNTg0MjE4Ny4xNjg5MTcxMjMz*_ga_N4RTJ5D08B*czE3NDc5MTgyNDIkbzEkZzEkdDE3NDc5MTg1MTYkajAkbDAkaDA" target="_blank">changes</a> to the bill before its passage. See some of the changes below and watch for an updated Legislative Advisory with a summary of provisions included in the bill.</li><li><strong>AHA Statement Submitted to Congressional Offices.</strong> The AHA, prior to the House vote, shared a <a href="g/press-releases/2025-05-21-aha-statement-house-reconciliation-legislation">statement</a> from AHA President and CEO Rick Pollack with congressional offices and the media.</li><li><strong>Advocacy Resources.</strong> The AHA has many resources that hospital and health system leaders can use as part of their advocacy efforts as attention turns to the Senate.</li></ul><h2>Changes to the Bill</h2><p>The House made several changes to the bill, including provisions that would affect Medicaid and the Health Insurance Marketplaces. Some of the changes include:</p><p>Watch for an updated Legislative Advisory for a detailed summary of provisions that affect hospitals and health systems.</p><h2>AHA Statement Shared with Congressional Offices and Media</h2><p>Prior to the House voting on the bill, AHA shared the following <a href="/press-releases/2025-05-21-aha-statement-house-reconciliation-legislation">statement</a> from AHA President and CEO Rick Pollack with congressional offices and the media.</p><p>“On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) is sharing our concerns about the One Big Beautiful Bill Act (OBBBA) that is being considered on the House floor this week.</p><p>“Our hospitals and health systems have significant concerns regarding the harmful Medicaid and Health Insurance Marketplace provisions currently included in the bill. The sheer magnitude of the level of reductions to the Medicaid program alone will impact all patients, not just Medicaid beneficiaries, in every community across the nation. Hospitals — especially in rural and underserved areas — will be forced to make difficult decisions about whether they will have to reduce services, reduce staff and potentially consider closing their doors. Other impacts could include longer waiting times to receive care, more crowded emergency departments, and hospitals not being able to invest in technology and innovations for clinical care.</p><p>“In particular, the Medicaid legislative proposals severely restrict the use of legitimate state funding resources and supplemental payment programs, including provider taxes and state directed payments, under the guise of eliminating waste, fraud and abuse. We reject this notion as these critical, legitimate and well-established Medicaid financing programs are essential to offset decades of chronic underpayments of the cost of care provided to Medicaid patients. These new policies are estimated to decimate federal support for the Medicaid program by more than $700 billion over 10 years and will displace health care coverage for millions of Americans, moving them from insured to uninsured status.</p><p>“In addition to jeopardizing access to patient care and services, these abrupt policy changes would upend state government budgets and threaten the viability of the health care system to provide essential services to this population. Since these changes are effective immediately upon enactment of the legislation, states will have little or no time to prepare for the significant financial impact on state budgets.</p><p>“Given the substantial reduction in Medicaid payments and cuts to the Health Insurance Marketplaces, including allowing the enhanced premium tax credits to expire, millions will lose health care coverage. Therefore, the AHA urges the House to reject efforts to dismantle these vital programs in the OBBBA and preserve health care access for our nation’s vulnerable and working families.”</p><h2>Advocacy Resources and Engage Your Senators</h2><p>After the House passage of the bill, attention now shifts to the Senate, which is expected to consider changes to the bill. Hospital and health system leaders are encouraged to use the upcoming Memorial Day recess to contact their senators and urge them to reject harmful provisions that would jeopardize access to coverage and care for millions of Americans across the country.</p><p>As you tell the story about what the bill’s impact would mean for your patients and communities and your organization’s ability to provide 24/7 care and services, please use the following AHA resources to assist your efforts.</p><ul><li><strong>Digital Toolkit.</strong> Use this toolkit to engage stakeholders, such as your hospital or health system teams and community leaders, in joining the fight to protect Medicaid. The <a href="/advocacy/advocacy-issues/medicaid">toolkit</a> includes a Medicaid Made Simple video, sample social media posts, stakeholder messages and newsletter copy.</li><li><strong>Fact Sheets and Infographics.</strong> The AHA has developed a series of fact sheets and infographics to inform your advocacy efforts. Visit the <a href="/advocacy/advocacy-issues/medicaid">Medicaid Advocacy Issue</a> page.</li><li><strong>Coalition to Strengthen America’s Health Care Resources.</strong> The <a href="https://strengthenhealthcare.org/" target="_blank">Coalition to Strengthen America’s Healthcare</a>, of which the AHA is a founding member, has many digital resources and tools that can assist your advocacy efforts.</li></ul><h2>Further Questions</h2><p>Visit the <a href="g/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/SB-House-Passes-Reconciliation-Bill-with-Significant-Policy-Changes-and-Reductions-to-Medicaid-Other-Health-Care-Programs.pdf"><img src="/sites/default/files/inline-images/Page-1-SB-House-Passes-Reconciliation-Bill-with-Significant-Policy-Changes-and-Reductions-to-Medicaid-Other-Health-Care-Programs.png" data-entity-uuid="6b4a4438-2190-4839-b61f-e7b9d51060e8" data-entity-type="file" alt="Special Bulletin: House Passes Reconciliation Bill with Significant Policy Changes and Reductions to Medicaid, Other Health Care Programs page 1." width="695" height="900"></a></div></div></div> Thu, 22 May 2025 12:31:14 -0500 Advocacy & Public Policy /press-releases/2025-05-21-aha-statement-house-reconciliation-legislation <div class="row"><div class="col-md-2"><p>Contact:</p></div><div class="col-md-10"><p>Colleen Kincaid, <a href="mailto:ckincaid@aha.org?subject=RE: AHA Statement on House Reconciliation Legislation">ckincaid@aha.org</a><br>Colin Milligan, <a href="mailto:cmilligan@aha.org?subject=RE: AHA Statement on House Reconciliation Legislation">cmilligan@aha.org</a></p></div></div><p><strong>Rick Pollack</strong><br><strong>President and CEO</strong><br><strong>���������� Association</strong></p><p>May 21, 2025</p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) is sharing our concerns about the One Big Beautiful Bill Act (OBBBA) that is being considered on the House floor this week.</p><p>Our hospitals and health systems have significant concerns regarding the harmful Medicaid and Health Insurance Marketplace provisions currently included in the bill. The sheer magnitude of the level of reductions to the Medicaid program alone will impact all patients, not just Medicaid beneficiaries, in every community across the nation. Hospitals — especially in rural and underserved areas — will be forced to make difficult decisions about whether they will have to reduce services, reduce staff and potentially consider closing their doors. Other impacts could include longer waiting times to receive care, more crowded emergency departments, and hospitals not being able to invest in technology and innovations for clinical care.</p><p>In particular, the Medicaid legislative proposals severely restrict the use of legitimate state funding resources and supplemental payment programs, including provider taxes and state directed payments, under the guise of eliminating waste, fraud and abuse. We reject this notion as these critical, legitimate and well-established Medicaid financing programs are essential to offset decades of chronic underpayments of the cost of care provided to Medicaid patients. These new policies are estimated to decimate federal support for the Medicaid program by more than $700 billion over 10 years and will displace health care coverage for millions of Americans, moving them from insured to uninsured status.</p><p>In addition to jeopardizing access to patient care and services, these abrupt policy changes would upend state government budgets and threaten the viability of the health care system to provide essential services to this population. Since these changes are effective immediately upon enactment of the legislation, states will have little or no time to prepare for the significant financial impact on state budgets.</p><p>Given the substantial reduction in Medicaid payments and cuts to the Health Insurance Marketplaces, including allowing the enhanced premium tax credits to expire, millions will lose health care coverage. Therefore, the AHA urges the House to reject efforts to dismantle these vital programs in the OBBBA and preserve health care access for our nation’s vulnerable and working families.</p><p>###</p> Wed, 21 May 2025 21:21:48 -0500 Advocacy & Public Policy /news/headline/2025-05-19-house-budget-committee-advances-reconciliation-bill <p>The House Budget Committee May 18 advanced the <a href="https://docs.house.gov/meetings/BU/BU00/20250516/118284/BILLS-119pih.pdf">fiscal year 2025 budget reconciliation bill</a> by a 17-16 vote along party lines, as four Republicans who previously opposed the bill in a May 16 markup flipped to “present” in yesterday’s tally. That group consisted of Reps. Ralph Norman, R-S.C., Chip Roy, R-Texas, Andrew Clyde, R-Ga., and Josh Brecheen, R-Okla. <br><br>The bill includes significant changes and cuts to Medicaid. It is expected to be considered by the House Rules Committee by midweek, with the possibility of additional text changes, and a full House vote by the end of the week. </p> Mon, 19 May 2025 16:20:43 -0500 Advocacy & Public Policy <p>The States Issues Forum featured a compelling panel discussion with Jared Kosin, President and CEO of the Alaska Hospital & Healthcare Association; Neda Jasemi, Senior Policy Analyst at the National Association of Medicaid Directors (NAMD); and Shelby Kerns, Executive Director of the National Association of State Budget Officers (NASBO).</p><p>The panel explored the timely topic of “State Budgets in a Time of Federal Funding Uncertainty.” With federal funding under increased scrutiny and broader economic instability on the horizon, states face critical decisions in their fiscal planning. A central concern is the potential for Medicaid funding cuts, which could significantly affect access to care for vulnerable populations—including children, older adults, individuals with disabilities, and low-income communities.</p><p>Panelists shared valuable insights on how Medicaid Directors and State Budget Officers are responding to these challenges, working to maintain access to care despite growing budgetary pressures.</p><p>Meeting Materials: </p><ul><li><a href="/system/files/media/file/2025/05/SIF%20Agenda_May%202025_Final.pdf" download="file" target="_blank">Agenda</a></li><li><a href="/system/files/media/file/2025/05/AHA%20State%20Issues%20Forum%20May%202025.pdf" download="file" target="_blank">Presentation Slides </a></li></ul> Wed, 14 May 2025 11:30:26 -0500 Advocacy & Public Policy /news/headline/2025-05-13-markup-begins-aha-issues-detailed-comments-ec-bill-medicaid-changes <p>The House Energy and Commerce Committee May 13 began to mark up its portion of the fiscal year 2025 reconciliation bill. The committee has been instructed to reduce deficits by $880 billion, with significant Medicaid changes and cuts being considered.</p><p>The AHA May 13 sent a detailed <a href="/system/files/media/file/2025/05/aha-house-statement-on-full-committee-markup-of-budget-reconciliation-text-testimony-5-13-2025.pdf" target="_blank">statement</a> to the E&C Committee with comments on certain sections of the bill, including potential changes to policies related to provider taxes and state directed payments, among other provisions.</p><p>Specifically, the bill would freeze, at current rates and amounts, what states can assess through provider taxes as of the date of enactment of this legislation and prohibits states from establishing new provider taxes.</p><p>“The AHA is greatly concerned about the significant disruption this policy change will have on states’ ability to fund their Medicaid programs,” the AHA said. “We believe the proposed restrictions on provider taxes fail to recognize the critical role they play in closing significant gaps in the cost of care for essential services.”</p><p>In addition, the bill directs the Department of Health and Human Services to revise current regulations to limit state-directed payments for services furnished on or after the enactment of this legislation from exceeding the total published Medicare payment rate.</p><p>SDPs are used to support essential hospital services, including behavioral health and obstetrical services, and to create incentives to improve quality and health outcomes. They are particularly important in rural areas, where hospitals are sometimes the sole source of care in a community.</p><p>“Setting limits on the amount that can be paid for SDPs into perpetuity will impact the delivery of care for both Medicaid beneficiaries as well as the larger communities served by our hospitals and health systems,” the AHA said.</p><p><strong>View AHA’s detailed </strong><a href="/system/files/media/file/2025/05/aha-house-statement-on-full-committee-markup-of-budget-reconciliation-text-testimony-5-13-2025.pdf" target="_blank"><strong>comments</strong></a><strong> submitted to the E&C committee. AHA May 12 shared a </strong><a href="/advisory/2025-05-12-aha-summary-house-energy-and-commerce-legislative-language" target="_blank"><strong>Legislative Advisory</strong></a><strong> with summaries of provisions included in the bill.</strong></p><p>The May 13 E&C Committee markup is expected to last well into the night or tomorrow morning. AHA will continue to provide updates.</p> Tue, 13 May 2025 17:32:53 -0500 Advocacy & Public Policy