/ en Tue, 19 Aug 2025 08:17:29 -0500 Fri, 01 Aug 25 13:43:19 -0500 /advisory/2025-07-03-key-highlights-final-one-big-beautiful-bill-act <div class="container"><div class="row"><div class="col-md-8"><p>The Senate July 1, and the House July 3, passed a budget reconciliation bill, the <a href="https://sponsors.aha.org/rs/710-ZLL-651/images/07032025-Legis-language-h1_eas.pdf" target="_blank" title="Full text of the One Big Beautiful Bill Act (OBBBA) PDF.">One Big Beautiful Bill Act (OBBBA)</a>, H.R. 1, a sweeping package that enacts many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill includes significant policy changes to Medicaid and the Health Insurance Marketplaces.</p><p>The Medicaid program provides health insurance coverage for 72 million Americans, including children, pregnant women, the elderly, the disabled and millions of working Americans. According to the <a href="https://www.cbo.gov/publication/61534" target="_blank" title="Congressional Budget Office: Estimated Budgetary Effects of an Amendment in the Nature of a Substitute to H.R. 1, the One Big Beautiful Bill Act, Relative to CBO's January 2025 Baseline">Congressional Budget Office</a> (CBO) score of a draft version of the Senate bill, the OBBBA will lead to nearly $1 trillion in Medicaid cuts and result in more than 11.8 million people losing Medicaid and health insurance marketplace coverage.</p><p>Historically, provider taxes and state-directed payments (SDPs) allow hospitals to bridge the chronic and historic underpayment by Medicaid for the care they deliver. The legislation includes limitations on the use of provider taxes and SDPs. The CBO score for the policy changes related to SDPs and provider taxes is $340 billion and will result in direct decreases in hospital payments. The AHA estimates that the provider tax changes alone will result in a loss of federal payments to hospitals of $232 billion over 10 years.</p><h2>AHA Statement</h2><p>In a <a href="/press-releases/2025-07-03-aha-statement-house-passage-one-big-beautiful-bill-act" target="_blank" title="AHA Statement on House Passage of One Big Beautiful Bill Act">statement</a> shared with the media following passage in the House July 3, AHA President and CEO Rick Pollack said, “Today is an extremely disappointing and very difficult day for health care in America. Despite months of clearly demonstrating the implications that these Medicaid proposals will have on the patients and communities we serve, especially the most vulnerable populations, Congress has enacted cuts of nearly a trillion dollars to the Medicaid program. No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage — cannot be simply dismissed as waste, fraud, and abuse. The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.</p><p>“The AHA remains committed to working with all stakeholders to mitigate the impact of these cuts wherever possible. Our goal is to help ensure hospitals can remain open for their communities, and people can get the care they need when they need it. Our nation’s health and economic future depend on it.”</p><h2>AHA Summary of OBBBA Provisions Impacting Hospitals and Health Systems</h2><h3>SUBTITLE B — HEALTH</h3><h3>Chapter 1 — Medicaid</h3><h3><em>Subchapter A — Reducing Fraud and Improving Enrollment Processes</em></h3><h4>Section 71101: Moratorium on Implementation of Medicaid Savings Program Eligibility and Enrollment Rule (Effective from enactment through Sept. 30, 2034)</h4><p>Prohibits the Department of Health and Human Services (HHS) Secretary from implementing, administering or enforcing the amendments made by 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. CBO estimates that this provision will result in a $85.3 billion reduction in federal spending over 10 years.</p><h4>Section 71102: Moratorium on Implementation of Medicaid, CHIP and Basic Health Program Eligibility and Enrollment Rule (Effective from enactment through Sept. 30, 2034)</h4><p>Prohibits the HHS secretary from implementing, administering or enforcing the amendments made by the provisions of 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 also would 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. CBO estimates that this provision will result in a $81.6 billion reduction in federal spending over 10 years.</p><h4>Section 71107: Eligibility Redeterminations (Effective Jan. 1, 2027)</h4><p>Requires states to redetermine eligibility once every six months for beneficiaries enrolled through the Medicaid expansion eligibility pathway, beginning in calendar year (CY) 2027. The HHS secretary must issue guidance related to implementing the rule no later than 180 days after enactment. The bill appropriates $75 million to the Centers for Medicare & Medicaid Services (CMS) administrator for fiscal year (FY) 2026 for implementation of the provisions. CBO estimates that this provision will result in a $62.6 billion reduction in federal spending over 10 years.</p><h4>Section 77109: Alien Medicaid Eligibility (Effective Oct. 1, 2026)</h4><p>Restricts eligibility for Medicaid to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. The bill appropriates $15 million to the CMS administrator for FY 2026 for implementation of the provisions. CBO estimates that this provision will result in a $6.2 billion reduction in federal spending over 10 years.</p><h4>Section 7110: Expansion FMAP for Emergency Medicaid (Effective Oct. 1, 2026)</h4><p>Beginning Oct. 1, 2026, the bill limits the Federal Medical Assistance Percentage (FMAP) to the state’s traditional FMAP for emergency Medicaid services provided to unlawfully present aliens who, except for their immigration status, would qualify for Medicaid expansion. The bill appropriates $1 million for FY 2026 to the CMS administrator for implementation of the provision. CBO estimates that this provision will result in a $28.2 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter B — Preventing Wasteful Spending</em></h3><h4>Section 71111: Moratorium on Implementation of Rule Relating to Staffing Standards for Long-term Care Facilities Under the Medicare and Medicaid Programs (Effective from enactment through Sept. 30, 2024)</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. CBO estimates that this provision will result in a $23.1 billion reduction in federal spending over 10 years.</p><h4>Section 71112: Reducing State Medicaid Costs (Effective Jan. 1, 2027)</h4><p>Limits the timeframe for retroactive Medicaid and CHIP eligibility to 30 days prior to the application date for expansion enrollees, and 60 days prior to the application date for traditional enrollees, as opposed to the current 90-day period. CBO estimates that this provision will result in a $4.2 billion reduction in federal spending over 10 years.</p><h4>Section 71113: Federal Payments to Prohibited Entities (Effective on enactment into 2026)</h4><p>Prohibits states from receiving federal matching funds for services rendered by providers who provide abortions (other than Hyde Amendment exceptions) and receive more than $800,000 in Medicaid payments in 2023. This applies to not-for-profit, essential community providers primarily engaged in family planning services, reproductive health and related medical care. This provision applies for one year, beginning on the date of enactment. The bill appropriates $1 million for FY 2026 to the CMS administrator for implementation of the provisions. CBO estimates that this provision will result in a $52 million increase in federal spending over 10 years.</p><h3><em>Subchapter C — Stopping Abusive Financing Practices</em></h3><h4>Section 71114: Sunsetting Increased FMAP Incentive. (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. CBO estimates that this provision will result in a $13.6 billion reduction in federal spending over 10 years.</p><h4>Section 71115: Provider Taxes (Freeze effective upon enactment; reduction begins Oct. 1, 2027)</h4><p>Freezes existing provider taxes imposed by a state or local unit of government as of the date of enactment. Removes the ability of a state or local unit of government to impose a new provider tax after enactment by setting the “hold harmless threshold” at 0%. Beginning in FY 2028, the hold harmless threshold for <strong>expansion states</strong> with an existing tax will be reduced by 0.5% annually until the threshold reaches 3.5% in 2032. Provider taxes in non-expansion states and provider taxes imposed on nursing homes and intermediate care facilities will remain frozen at their rates as of enactment. The bill appropriates $20 million for FY 2026 to the CMS administrator for implementation of the provisions. CBO estimates that this provision will result in a $191.1 billion reduction in federal spending over 10 years.</p><h4>Section 71116: State-directed Payments (SDP cap effective on enactment; reduction effective by the rating period on or after Jan. 1, 2028)</h4><p>Caps SDPs at 100% of the total published Medicare rate in expansion states and 110% of the total published Medicare rate in non-expansion states. SDPs approved (or where there was a good faith effort to be approved) by May 1, 2025, and SDP payments for rural hospitals approved (or where there was a good faith effort to be approved) by enactment will be grandfathered in at a higher rate. Completed preprints for SDPs can be submitted until enactment and may be grandfathered in at a higher rate. Beginning with the rating period on or after Jan. 1, 2028, all grandfathered SDPs would be reduced by 10 percentage points annually until the specified Medicare payment rate limit is achieved. The total published Medicare rate is defined as provided in 438.6(a) of title 42 of the Code of Federal Regulations or any future regulation that replaces it. Rural hospitals are defined as those located in a rural area, treated as being in a rural area, or located in a rural census tract, as well as critical access hospitals, sole community hospitals, Medicare-dependent hospitals, low-volume hospitals and rural emergency hospitals. The bill appropriates $7 million for each FY between 2026 and 2033 for the implementation of the provision. CBO estimates that this provision will result in a $149.4 billion reduction in federal spending over 10 years.</p><h4>Section 71117: Requirements Regarding Waiver of Uniform Tax Requirement for Medicaid Provider Tax (Effective upon enactment)</h4><p>Modifies the requirements regarding the uniformity of provider taxes and, specifically, whether a state’s tax is considered “generally redistributive.” A tax will not be 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><p>The HHS secretary will determine an applicable transition period (up to three years) for taxes considered not generally redistributive. CBO estimates that this provision will result in a $34.6 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter D — Increasing Personal Accountability</em></h3><h4>Section 71119: Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals (Effective Dec. 31, 2026)</h4><p>Requires certain nonpregnant, nondisabled adult Medicaid beneficiaries to meet certain community engagement requirements (work requirements) beginning Dec. 31, 2026. Individuals must work or engage in qualifying activities (e.g., community service, educational programs, job training) for no less than 80 hours per month. The legislation exempts, among other groups, parents, guardians and caretaker relatives of children aged 14 or under, or disabled individuals. States are permitted to receive temporary exemptions with HHS approval. The legislation limits the types of entities that can contract with states to help implement this provision, effectively barring Medicaid managed care plans from assisting. The bill provides $200 million in FY 2026 for state implementation and $50 million for federal administration. CBO estimates that this provision will result in a $325.8 billion reduction in federal spending over 10 years.</p><h4>Section 71120: Modifying Cost-sharing Requirements for Certain Expansion Individuals Under the Medicaid Program (Effective Oct. 1, 2028)</h4><p>Requires Medicaid expansion enrollees with incomes above 100% of the federal poverty level to pay up to $35 in cost sharing per service. Cost sharing for non-emergency services provided in a hospital emergency department may exceed $35. The provision will exclude certain services, including primary care, pregnancy-related services, mental health or substance use disorder services. Total cost sharing may not exceed 5% of family income. CBO estimates that this provision will result in a $7.5 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter E — Expanding Access to Care</em></h3><h4>Section 71121: Making Certain Adjustments to Coverage of Home or Community-based Services Under Medicaid (Effective July 1, 2028)</h4><p>Provides states with the option to pursue a standalone waiver under section 1915(c) and expand access to home and community-based services. The bill appropriates $50 million for FY 2026 to the HHS secretary for implementation of the provisions. Further, the bill appropriates $100 million for FY 2027 for making payments to states delivering home or community-based services. CBO estimates that this provision will result in a $6.6 billion increase in federal spending over 10 years.</p><h3>Chapter 2 — Medicare</h3><h3><em>Subchapter A — Strengthening Eligibility Requirements</em></h3><h4>Section 71201: Limiting Medicare Coverage of Certain Individuals (Effective 18 months from enactment)</h4><p>Restricts eligibility for Medicare for non-citizens to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. CBO estimates that this provision will result in a $5.1 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter B — Improving Services for Seniors</em></h3><h4>Section 71202: Temporary Payment Increase Under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances (Effective Jan. 1, 2026)</h4><p>Provides a rate update to the Physician Fee Schedule of 2.5% for calendar year (CY) 2026 only. There is no adjustment for CY 2025. CBO estimates that this provision will result in a $1.9 billion increase in federal spending over 10 years.</p><h4>Section 71203: Expanding and Clarifying the Exclusion for Orphan Drugs Under the Drug Price Negotiation Program (Effective Jan. 1, 2028)</h4><p>Modifies the Inflation Reduction Act to exclude orphan drugs under the Drug Price Negotiation Program. CBO estimates that this provision will result in a $4.9 billion increase in federal spending over 10 years.</p><h3>Chapter 3 — Health Tax</h3><h3><em>Subchapter A — Improving Eligibility Criteria</em></h3><h4>Section 71301: Permitting Premium Tax Credit Only for Certain Individuals (Effective Jan. 1, 2027)</h4><p>Restricts eligibility premium tax credits for marketplace coverage for non-citizens to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. CBO estimates that this provision will result in a $69.8 billion reduction in federal spending over 10 years.</p><h4>Section 71302: Disallowing Premium Tax Credits During Periods of Medicaid Ineligibility Due to Alien Status (Effective Jan. 1, 2026)</h4><p>Disallows undocumented immigrants who report income below 100% of the federal poverty level and are in their five-year Medicaid waiting period (due to immigration status) from receiving premium tax credits to purchase health insurance on the marketplaces. CBO estimates that this provision will result in a $49.5 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter B — Preventing Waste, Fraud and Abuse</em></h3><h4>Section 71303: Requiring Verification of Eligibility for the Premium Tax Credit (Effective Jan. 1, 2028)</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 will prohibit automatic reenrollment for enrollees receiving premium tax credits by requiring them to actively prove tax credit eligibility each year. CBO estimates that this provision will result in a $36.9 billion reduction in federal spending over 10 years.</p><h4>Section 71304: Disallowing Premium Tax Credit in Case of Certain Coverage Enrolled in During the Special Enrollment Period (Effective Jan. 1, 2026)</h4><p>Prohibits individuals from receiving premium tax credits if they enroll in health coverage on the marketplace through a special enrollment period associated with their income. CBO estimates that this provision will result in a $39.5 billion reduction in federal spending over 10 years.</p><h4>Section 71305: Eliminating Limitation on Recapture of Advance Payment of Premium Tax Credit (Effective Jan. 1, 2026)</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. CBO estimates that this provision will result in a $17.3 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter C — Enhancing Choice For Patients</em></h3><h4>Section 71306: Permanent Extension of Safe Harbor for Absence of Deductible for Telehealth Services (Effective Jan. 1, 2025)</h4><p>Provides a safe harbor to allow telehealth services to be provided pre-deductible for patients with high-deductible health plans. CBO estimates that this provision will result in a $4.3 billion reduction in federal revenue over 10 years.</p><h4>Section 71307: Allowance of Bronze and Catastrophic Plans in Connection with Health Savings Accounts (Effective Jan. 1, 2026)</h4><p>Allows bronze and catastrophic plans to contribute to health savings accounts. CBO estimates that this provision will result in a $3.6 billion reduction in federal revenue over 10 years.</p><h4>Section 71308: Treatment of Direct Primary Care Service Arrangements (Effective Jan. 1, 2026)</h4><p>Allows individuals in high-deductible health plans to enroll in direct primary care service arrangements and to use their health savings accounts for payment. CBO estimates that this provision will result in a $2.8 billion reduction in federal revenue over 10 years.</p><h3>Chapter 4 — Protecting Rural Hospitals and Providers</h3><h4>Section 71401: Rural Health Transformation Program (Effective upon enactment)</h4><p>Creates a rural stabilization fund with $50 billion, to be paid out as $10 billion annually across FYs 2026 through 2030. States will need to submit a one-time application to CMS to be eligible for an allotment of these funds during a submission period specified by CMS (with an application and decision date no later than Dec. 31, 2025). Of the $50 billion in funding, 50% of the funds for each fiscal year will be equally distributed among all the states with an approved application. Forty percent of the funds for each fiscal year will be distributed in a method determined by CMS. CMS will consider the following as its distribution method: the percentage of the state population located in rural geographies, the proportion of rural health facilities in the state relative to the nation, and any other factors deemed appropriate by CMS. Not more than 10% of the amount allocated to the states can be used for administrative expenses. Separately, the legislation appropriates $200 million to the CMS administrator for FY 2025 to implement the provision.</p><h3>SUBTITLE A — TAX</h3><h3>Chapter 4 — Investing In American Families, Communities and Small Businesses</h3><h3><em>Subchapter B — Permanent Investments in Students and Reforms to Tax-Exempt Institutions</em></h3><h4>Section 70415: Endowment Tax for Universities (Effective Jan. 1, 2026)</h4><p>Amends the excise tax rate for universities based on student endowments. The rates are as follows: 1.4% for student endowments ranging from $500,000-$750,000 , 4% for student endowments ranging from $750,000-$2 million, and 8% for all student endowments above $2 million. CBO estimates that this provision will result in a $761 million increase in federal revenue over 10 years.</p><h4>Section 70416: Executive Compensation (Effective Jan. 1, 2026)</h4><p>Limits tax-exempt organizations’ ability to deduct compensation over $1 million, including for former employees, dating back to tax year 2017. CBO estimates that this provision will result in a $3.8 billion increase in federal revenue over 10 years.</p><h3><em>Subchapter C — Permanent Investments in Community Development</em></h3><h4>Section 70426: One Percent Floor on Deduction of Charitable Contributions Made by Corporations (Effective Jan. 1, 2026)</h4><p>Allows a deduction for corporate charitable contributions only to the extent that the aggregate of corporate charitable contributions exceeds 1% of a taxpayer’s taxable income and does not exceed 10% of the taxpayer’s taxable income. CBO estimates that this provision will result in a $16.6 billion increase in federal revenue over 10 years.</p><h3>Chapter 5 — Ending Green New Deal Spending, Promoting America-First Energy and Other Reforms</h3><h3><em>Subchapter A — Termination of Green New Deal Subsidies</em></h3><h4>Section 70503: Termination of Qualified Commercial Clean Vehicles Credit (Credit terminates Sept. 30, 2025)</h4><p>Eliminates the tax credit that allowed for tax-exempt entities to receive a direct payment for the lesser of 1) 15% of the vehicle’s cost (30% for vehicles not powered by gas or diesel) or 2) the incremental cost of the vehicle relative to a comparable vehicle. CBO estimates that this provision will result in a $104.5 billion increase in federal revenue over 10 years.</p><h4>Section 70504: Termination of Alternative Fuel Vehicle Refueling Property Credit (Credit terminates June 30, 2026)</h4><p>Eliminates the tax credit that allowed for a tax-exempt owner of property to receive direct payment for the cost of installing a qualified alternative fuel vehicle refueling station on property, such as electric charging stations CBO estimates that this provision will result in a $1.96 billion increase in federal revenue over 10 years.</p><h4>Section 70507: Termination of Energy Efficient Commercial Buildings Deduction (Deduction terminates June 30, 2026)</h4><p>Eliminates a tax deduction for tax-exempt organizations for energy-saving commercial building property. The deduction will terminate for any property with construction beginning after June 30, 2026. CBO estimates that this provision will result in a $134 million increase in federal revenue over 10 years.</p><h4>Section 70513: Termination and Restrictions on Clean Electricity Investment Credit (Credit terminates Dec. 31, 2027)</h4><p>Eliminates a tax credit for investing in qualifying zero-emission electricity generation facilities or energy storage technology. Under the previous law, the credit was phased out in 2032. Specifically, this provision:</p><ul><li>Terminates eligibility for covered wind and solar facilities placed into service after Dec. 31, 2027.</li><li>Increases the domestic content requirement for projects to be eligible for the domestic content bonus. The current law requires that 40% of the manufactured products in a facility be from a domestic source. The act will increase the required threshold to 45% (or 27.5% for offshore wind) from June 16, 2025, until Dec. 31, 2025; 50% (or 35% for offshore wind) for CY 2026; and 55% after Dec. 31, 2026.</li><li>Prevents access to credits for wind and solar if the taxpayer rents or leases the property to a third party.</li><li>Prohibits credits that include any material assistance from a prohibited foreign entity.</li></ul><p>Additionally, the bill eliminates the investment tax credit for certain energy properties for qualified projects. Specifically, the provision eliminates the 2% base credit for projects not meeting prevailing wage and apprenticeship requirements, applies to construction beginning on or after June 16, 2025.CBO estimates that this provision will result in a $177.9 billion increase in federal revenue over 10 years.</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></div><div class="col-md-4"><div class="sticky"><a href="/system/files/media/file/2025/07/Legislative-Advisory-Key-Highlights-of-the-Final-One-Big-Beautiful-Bill-Act.pdf" target="_blank" title="Click here to download the Legislative Advisory: Key Highlights of the Final One Big Beautiful Bill Act PDF."><img src="/sites/default/files/inline-images/Page-1-Legislative-Advisory-Key-Highlights-of-the-Final-One-Big-Beautiful-Bill-Act.png" data-entity-uuid="6a061d3b-a8fa-410e-baa3-17eaad87d657" data-entity-type="file" alt="Legislative Advisory: Key Highlights of the Final One Big Beautiful Bill Act page 1." width="696" height="900"></a></div></div></div></div> div.sticky { position: sticky; top: 0; } Thu, 03 Jul 2025 00:00:01 -0500 Legislation and Legislative Advocacy /fact-sheets/2025-02-07-fact-sheet-budget-reconciliation-101 <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p>Budget reconciliation is an optional process under the Congressional Budget Act of 1974 that allows for expedited consideration of certain fiscal legislation that makes changes to mandatory spending, revenues and/or the debt limit. This special fast-track procedure is designed to reconcile current law with assumptions contained in the annual budget resolution adopted by Congress. Reconciliation legislation is privileged and cannot be filibustered in the Senate, meaning it requires only a simple majority, instead of a three-fifths majority, to pass. The contents of a reconciliation bill are tightly controlled because the process restricts the Senate’s right to unlimited debate that exists for most other legislation. The Senate’s “Byrd rule” aims to prevent the inclusion of matter considered “extraneous” to the budgetary goals of the legislation. In recent years, reconciliation has been used to enact landmark fiscal legislation on a party line basis. The most recent examples include the Tax Cuts and Jobs Act (2017), the American Rescue Plan (2021) and the Inflation Reduction Act (2022).</p><h2>Understanding the Basics</h2><h3>Step 1: Budget Resolution</h3><ul><li>Before Congress can begin work on a reconciliation bill, it must first pass a concurrent budget resolution in the House and Senate. A budget resolution serves as a roadmap to guide fiscal decision-making in Congress. Unlike other bills, it does not go to the President’s desk for signature and does not have the force of law. A budget resolution that is being used for reconciliation will contain a series of “reconciliation instructions” to various committees of jurisdiction directing them to report legislation that meets a specified fiscal target, such as requiring a committee to reduce mandatory spending by no less than a certain amount or reduce revenue by no more than a certain amount. The numerical instructions provide the fiscal goals of the legislation and cannot dictate the substance of how the committees are to meet their instructions. Nevertheless, which committees are given instructions, and the magnitude of those instructions, can be indicative of potential areas of focus.<ul><li><span><strong>Example:</strong></span> Instructions to the Energy & Commerce Committee directing them to reduce mandatory spending by a large amount opens the door to spending cuts within health programs.</li></ul></li></ul><h3>Step 2: Committees Begin Work on Reconciliation Bill</h3><ul><li>The instructed committees begin drafting legislation consistent with their instructions from the budget resolution and then move legislation through the committee process. The Budget Committee takes each committee-reported measure and combines them into a single reconciliation bill to prepare for consideration before the House or Senate.<ul><li><span><strong>Clarifying Point:</strong></span> Committees that did not receive reconciliation instructions in the budget resolution are not involved in the process. Committees cannot include subject matter outside of their jurisdiction.</li></ul></li></ul><h3>Step 3: Debate and Passage</h3><ul><li>The House and Senate have different rules that govern how legislation is considered by the full chamber. In the House, the Rules Committee will establish guidelines for debate on the bill and decide whether members will be allowed to make amendments to the bill. A reconciliation bill is passed in the House with a simple majority consistent with their typical process.</li><li>In the Senate, debate is limited to 20 hours and only 51 votes are needed to pass the bill instead of the usual 60 votes.<ul><li><span><strong>Clarifying Point:</strong></span> Even after the 20 hours of debate has expired, senators are allowed to offer amendments and make other motions on the bill. These extra votes are often referred to as “vote-a-rama.” Amendments are voted on without debate until no more amendments are offered. At that point, the Senate will vote on final passage of the reconciliation bill.</li></ul></li></ul><h3>Step 4: Resolving Differences & Final Approval</h3><ul><li>Before the reconciliation bill can be sent to the President for signature or veto, Congress must work out any remaining differences between the House and Senate bills. Once both chambers of Congress have passed an identical bill, the bill heads to the President’s desk.<ul><li><span><strong>Example:</strong></span> The House passes the reconciliation bill first and sends it to the Senate. The Senate passes amendments making changes to the bill. The House will need to vote on this new version before sending it to the President’s desk.</li></ul></li></ul><h2>Diving Deeper: The Byrd Rule</h2><h3>The Byrd Rule sets six criteria to determine whether a provision can be included in a reconciliation bill or whether it is considered extraneous.</h3><ul><li>A provision that violates any one of the six Byrd rule tests can be removed from the bill if a senator raises a Byrd rule point of order, unless 60 senators vote to waive the point of order to allow that provision to stay in the bill.<ul><li><span><strong>Clarifying Point:</strong></span> The Presiding Officer in the Senate makes the determination whether provisions are consistent with the rules, based on advice from the Senate Parliamentarian.</li><li><span><strong>Clarifying Point:</strong></span> The Byrd Rule only applies to consideration in the Senate. However, the House must be careful in crafting their bill to ensure it follows the Byrd Rules parameters otherwise it will put the bill at risk in the Senate.</li></ul></li></ul><h3>Six Criteria Used to Determine Whether a Provision is “Extraneous”:</h3><ol><li><span><strong>No Budgetary Effect:</strong></span> Provision does not change mandatory spending or revenues.</li><li><span><strong>Not in Accordance with Instructions:</strong></span> Provision increases mandatory spending or reduces revenues, and the committee is not in compliance with its instructions.</li><li><span><strong>Outside Committee Jurisdiction:</strong></span> Provision falls outside the jurisdiction of the instructed committee.</li><li><span><strong>Incidental Budgetary Effect:</strong></span> Provision produces a change in mandatory spending or revenues that is merely incidental to its other components.</li><li><span><strong>Increases Deficit Beyond the Budget Window:</strong></span> Provision would increase the deficit in any year beyond the period covered by a committee’s reconciliation instruction (usually 10 years).</li><li><span><strong>Changes to Social Security:</strong></span> Provision makes changes to Title II of the Social Security Act.</li></ol></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/02/Fact-Sheet-Budget-Reconciliation-101-20250207.pdf" target="_blank" title="Click here to download the Fact Sheet: Budget Reconciliation 101 PDF."><img src="/sites/default/files/inline-images/Page-1-Fact-Sheet-Budget-Reconciliation-101-20250207.png" data-entity-uuid="f869be09-95e9-467e-8c28-e7fc30015205" data-entity-type="file" width="695" height="900"></a></p><p><div class="views-element-container"><div class="js-view-dom-id-f159be41450e2eec50dd3ea4057be4ddadcc6864929c33f009a913bf5b62cf50"> <header> <h3>The Latest on the One Big Beautiful Bill Act</h3> </header> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care" hreflang="en">Chair File: The OBBBA and What’s Next for Health Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T10:16:20-05:00" title="Monday, July 28, 2025 - 10:16">Jul 28, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion" hreflang="en">CBO projects OBBBA to increase uninsured by 10 million, federal deficit by $3.4 trillion</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-21T15:37:59-05:00" title="Monday, July 21, 2025 - 15:37">Jul 21, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2025-07-16-aha-expresses-support-protect-medicaid-and-rural-hospitals-act" hreflang="en">AHA Expresses Support for Protect Medicaid and Rural Hospitals Act </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T14:21:17-05:00" title="Wednesday, July 16, 2025 - 14:21">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and" hreflang="en">Chair File: Leadership Dialogue — Continuing the Work to Strengthen Health in America With AHA President and CEO Rick Pollack</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T10:53:03-05:00" title="Wednesday, July 16, 2025 - 10:53">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025" hreflang="en">Resources on the One Big Beautiful Bill Act Signed Into Law July 4, 2025</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-15T14:49:30-05:00" title="Tuesday, July 15, 2025 - 14:49">Jul 15, 2025</time> </span> </div></div> <div class="more-link"><a href="/topics/budget-reconciliation">More on the One Big Beautiful Bill Act (OBBBA)</a></div> </div> </div> </p></div></div></div> h2 { color: #003087; } h3 { color: #002855; } .meta.custom-lock-position { position: relative; top: 0px; right: inherit; display: block; float: right; } .views-field-title { font-weight: bold; } .views-field-created { color: #000000 !important; } .views-row { margin-bottom: 20px; } .views-element-container { border: solid black 1px; padding-left: 20px; padding-right: 20px; padding-bottom: 20px; } Fri, 07 Feb 2025 14:23:32 -0600 Legislation and Legislative Advocacy /issue-landing-page/2025-02-07-budget-reconciliation-process-resource-page <div class="container"><div class="row"><div class="col-md-8"><h2>Reconciliation State of Play: 119th Congress</h2><p>This year, House and Senate Republicans are expected to use the budget reconciliation process to pass key agenda items on taxes, energy and border security, and they may look to health measures to pay for this legislation. Reconciliation is a complicated budget tool that gives Congress a fast-track mechanism to avoid the Senate filibuster and pass partisan legislation.</p><p>The following resources provide more details on the reconciliation process:</p><ul><li><a href="/fact-sheets/2025-02-07-fact-sheet-budget-reconciliation-101">AHA Fact Sheet: Budget Reconciliation 101</a></li><li><a href="https://www.youtube.com/watch?v=uVv3BlL8jwE&t=54s" target="_blank" title="YouTube: Budget Reconciliation">AHA Video: Understanding Budget Reconciliation</a></li><li><a href="https://crsreports.congress.gov/product/pdf/R/R44058" target="_blank">CRS Report: The Reconciliation Process: Stages of Consideration</a></li><li><a href="https://crsreports.congress.gov/product/pdf/RL/RL30862" target="_blank">CRS Report: The Reconciliation Process: The Senate’s Byrd Rule</a></li></ul></div><div class="col-md-4"><p><div class="views-element-container"><div class="js-view-dom-id-ba49c758aff4e35b94cdbfc2b77b1001bede71a3d26046fb971b4a6b086694f0"> <header> <h3>The Latest on the One Big Beautiful Bill Act</h3> </header> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care" hreflang="en">Chair File: The OBBBA and What’s Next for Health Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T10:16:20-05:00" title="Monday, July 28, 2025 - 10:16">Jul 28, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion" hreflang="en">CBO projects OBBBA to increase uninsured by 10 million, federal deficit by $3.4 trillion</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-21T15:37:59-05:00" title="Monday, July 21, 2025 - 15:37">Jul 21, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2025-07-16-aha-expresses-support-protect-medicaid-and-rural-hospitals-act" hreflang="en">AHA Expresses Support for Protect Medicaid and Rural Hospitals Act </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T14:21:17-05:00" title="Wednesday, July 16, 2025 - 14:21">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and" hreflang="en">Chair File: Leadership Dialogue — Continuing the Work to Strengthen Health in America With AHA President and CEO Rick Pollack</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T10:53:03-05:00" title="Wednesday, July 16, 2025 - 10:53">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025" hreflang="en">Resources on the One Big Beautiful Bill Act Signed Into Law July 4, 2025</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-15T14:49:30-05:00" title="Tuesday, July 15, 2025 - 14:49">Jul 15, 2025</time> </span> </div></div> <div class="more-link"><a href="/topics/budget-reconciliation">More on the One Big Beautiful Bill Act (OBBBA)</a></div> </div> </div> </p></div></div></div> Fri, 07 Feb 2025 08:12:54 -0600 Legislation and Legislative Advocacy /news/headline/2025-08-01-senate-committee-advances-appropriations-bill <p>The Senate Appropriations Committee July 31 advanced the fiscal year 2026 <a href="https://www.appropriations.senate.gov/imo/media/doc/fy26_lhhs_senate_report.pdf">appropriations bill</a> for the Departments of Labor, Health and Human Services, Education and other agencies by a bipartisan 26-3 <a href="https://www.appropriations.senate.gov/hearings/full-committee-markup-of-defense-and-labor-health-and-human-services-and-education-appropriations-acts">vote</a>. The bill provides approximately $197 billion in discretionary funding. It includes funding to programs the AHA requested in <a href="/news/headline/2025-06-18-aha-urges-lawmakers-support-key-areas-health-care-fy-2026-appropriations-bill">June</a>.   <br><br>The committee approved $309 million — an increase of $4 million — for Health Care Readiness and Recovery, formerly the Hospital Preparedness Program. It also provided $390 million for the Children’s Hospitals Graduate Medical Education program, a $21 million increase from FY 2024 enacted. The bill also includes some moderate funding increases for rural health, behavioral health, workforce, and maternal and child health programs. In addition, the bill <a href="https://www.appropriations.senate.gov/imo/media/doc/fy26_lhhs_senate_bill_summarypdf.pdf">provides</a> $48.7 billion in discretionary funding for the National Institutes of Health, an increase of $400 million, and rejects the initial White House proposal to cut $18 billion in funding. The bill also rejected the administration’s proposal to cap indirect cost rates for NIH grants at 15%.   <br><br>The House is expected to consider the bill in September.</p> Fri, 01 Aug 2025 13:43:19 -0500 Legislation and Legislative Advocacy /action-alert/2025-07-28-take-action-engage-lawmakers-august-build-support-key-priorities <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives has left Washington, D.C., for its August district work period, and senators could return to their states as early as next week. It is important to engage with your lawmakers while they are home and discuss the impact that the recently passed One Big Beautiful Bill Act and additional policy proposals that are under consideration will have on hospitals’ ability to provide care.</p><p>Funding for the federal government, including certain important health care programs, is set to expire Oct. 1. Congress must pass all 12 appropriations bills by Sept. 30 to fund the federal government for the next fiscal year. If lawmakers fail to meet that deadline, they will need to enact a continuing resolution temporarily extending current funding levels to avoid a government shutdown. However, these health care programs including Low-volume Adjustment and Medicare-Dependent Hospital, telehealth and hospital-at-home waivers — as well as prolonging Medicaid DSH cuts from going into effect — are not guaranteed to be extended. Additionally, Congress needs to act before the end of the year to extend the Enhanced Premium Tax Credits. Meanwhile, some legislators are discussing another reconciliation package on deficit reduction efforts. Those efforts could include additional Medicaid and Medicare cuts. It is important that your legislators understand hospitals and health systems cannot sustain any additional cuts, especially as we are facing the implementation of Medicaid cuts in the <a href="/advisory/2025-07-18-detailed-summary-one-big-beautiful-bill-act-obbba-public-law-no-119-21">OBBBA</a>.</p><p>While your lawmakers are home next month, please make plans to visit them in their offices, speak with them at a community event or invite them to your hospital to show them the importance of supporting policies that allow hospitals to provide care to their communities. And share with them the impact that funding reductions would have on your ability to provide services and care for the people they represent.</p><p>The following are some of the top priority issues and resources that can assist you and your team in conversations with your lawmakers.</p><h2>Advocacy Priorities</h2><ul><li><strong>Extend the </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits"><strong>Enhanced Premium Tax Credits</strong></a><strong>.</strong> The Enhanced Premium Tax Credits help individuals and families purchase insurance on the Health Insurance Marketplaces. Policies enabling these credits will expire at the end of 2025. Urge your members of Congress to extend the enhanced premium tax credits that enable millions of people to have health care coverage.</li><li><strong>Reject </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>Site-neutral Payments</strong></a><strong>.</strong> Site-neutral payments would compensate hospital outpatient departments the same as independent physician offices and other ambulatory sites of care, ignoring the very different level of care provided by hospitals and the needs of the patients and communities cared for in that setting. Ask your members of Congress to reject efforts to enact additional site-neutral payments proposals.</li><li><strong>Protect the </strong><a href="/fact-sheets/fact-sheet-340b-drug-pricing-program"><strong>340B Drug Pricing Program</strong></a><strong>.</strong> Hospitals depend on the 340B program to manage rising prescription drug costs and expand access to care for patients. Ask your members of Congress to oppose any harmful changes to the 340B program.</li><li><strong>Extend </strong><a href="/fact-sheets/2025-02-07-fact-sheet-telehealth"><strong>Telehealth</strong></a><strong> and </strong><a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program"><strong>Hospital-at-home</strong></a><strong> Programs.</strong> These programs enable providers to care for patients at home, without having to make long drives to a facility. These programs are set to expire Sept. 30. Urge your lawmakers to extend these programs so providers can ensure continuity of care.</li><li><strong>Prevent </strong><a href="/advocacy/advocacy-issues/medicaid-dsh-payment-cuts"><strong>Medicaid Disproportionate Share Hospital</strong></a><strong> Cuts.</strong> The Medicaid DSH program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations, including children and those who are disabled and elderly. The Medicaid DSH cut for fiscal year 2026 is $8 billion and will go into effect on Oct. 1 unless Congress acts. Urge your lawmakers to provide relief from the Medicaid DSH cuts given the vital need for the program.</li><li><strong>Extend the </strong><a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-rural-mdh-and-lva-programs"><strong>Low-volume Adjustment and Medicare-dependent Hospital</strong></a><strong> Programs.</strong> The enhanced low-volume adjustment and Medicare-dependent hospital programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. Without action from Congress, the enhanced LVA and MDH programs will expire Sept. 30. Urge your lawmakers to extend these vital programs.</li><li><strong>Protect </strong><a href="/fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response"><strong>Health Care Workers</strong></a><strong> from Violence.</strong> The Save Healthcare Workers Act (H.R. 3178/S. 1600) is bipartisan legislation (that would make it a federal crime to assault a hospital staff member on the job. Urge your lawmakers to support this legislation.</li></ul><h2>AHA Resources</h2><p>Your voice is extremely important and your legislators listen to you. Be ready to tell your hospital’s story. Prepare for a successful encounter with these <a href="/advocacy/2023-03-07-advocacy-tips-and-best-practices">tips and best practices</a> for meeting with lawmakers and hosting them at your hospital. Visit the <a href="/advocacy/action-center">AHA Action Center</a> for information and resources to assist you in your advocacy.</p><h2>Further Questions</h2><p>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/2025/07/Action-Alert-TAKE-ACTION-Engage-Lawmakers-in-August-to-Build-Support-for-Key-Priorities.pdf" target="_blank" title="Click here to download the Action Alert: TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities"><img src="/sites/default/files/inline-images/Page-1-Action-Alert-TAKE-ACTION-Engage-Lawmakers-in-August-to-Build-Support-for-Key-Priorities.png" data-entity-uuid="f8d7fe18-60fc-49cc-9704-cacdc239ac3a" data-entity-type="file" alt="Action Alert: TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities page 1." width="695" height="900"></a></div></div></div> Mon, 28 Jul 2025 15:43:12 -0500 Legislation and Legislative Advocacy /news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care <p>The recently enacted One Big Beautiful Bill Act will bring big changes to health care. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue conversation earlier this month to talk about the key provisions that apply to health care. If you missed that episode, you can <a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and">watch the video or listen to the podcast</a>.</p><p>Our health care field, supported by patch after patch since 1965, is not sustainable for today’s world of 2025. Some of the patches that we needed to keep going are gone, and it’s unrealistic to think they’re coming back. This time doesn’t just feel different, it is different. So what should we be focused on as hospitals and health systems?</p><p>First, we have to accept reality and make the smartest choices we can with the resources and constraints we have to maximize our delivery on our mission. The AHA has already begun some of this work and will be assisting hospitals to help individuals retain eligibility for coverage, as well as sharing best practices for improvements and operational efficiencies. We also are looking ahead at several hospital priorities that will need to be addressed before the end of the year — from waivers for telehealth and hospital at home, Medicaid disproportionate share hospital cuts, the Medicare rule making process, regulatory relief and more. Now more than ever, we are here to help you do what you do best: care for our communities.</p><p>While the AHA is pulling all the levers in Washington, D.C., to advocate for priorities that advance health, all of us have an important role to play in engaging our legislators. There’s nothing more powerful than hearing from you, their constituents, about the impact certain policies will have on the people they represent. You can find resources and more information on how to best do this below.</p><p>Our second, and most important, job is to actually reform and transform health care for the long term. We need to do the hard work and create a health care model that is sustainable for the world of 2065, not 1965. We have to start putting proposals on the table that challenge the status quo yet move us forward.</p><p>At the AHA Leadership Summit in Nashville last week, I heard so many incredible stories of how you have started this work. As a field, we are using technology and innovation to transform care delivery, improve quality and patient safety, and meet people where they need care. And that is what makes me hopeful and optimistic.</p><p>We’ve been dealt a difficult hand, but it’s our opportunity to open the door wide for transformation and innovation. We owe it to ourselves, our team members, our patients and our communities to make the very best choices we can today — and to transform our health care system for tomorrow.</p><h2>Helping You Help Communities — Key AHA Resources</h2><ul><li><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025">Advocacy Resources on OBBBA</a></li><li><a href="/advocacy/action-center">AHA Action Center</a></li><li><a href="/advocacy-issues">Key Advocacy Issues and Resources</a></li><li><a href="/advocacy/working-with-congress">Guide to Working with Congress</a></li></ul> Mon, 28 Jul 2025 10:16:20 -0500 Legislation and Legislative Advocacy /news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and <p>This month Congress enacted the One Big Beautiful Bill Act — a sweeping package that contained many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction, as well as significant policy changes to Medicaid and the Health Insurance Marketplaces.</p><p>This legislation will have a significant impact on hospitals and health systems as the changes are enacted. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue conversation to help us understand the key provisions that apply to health care. We discuss how the AHA is helping the field prepare for some of the law’s changes, as well as our ongoing efforts to mitigate some of the policies. No matter what, we are here for you so you can continue to provide the care and services that our communities depend on.</p><p>During the conversation, Rick and I also look ahead to the many key advocacy priorities that are still on the table for the remainder of the year, including several provisions that the AHA hopes to get enacted as part of a government funding bill at the end of September.</p><p>Grassroots advocacy and sharing stories with your legislators about the real-world impact the policies they enact will have on patients and communities remain vital, and we close our conversation by exploring what this looks like for hospitals and health systems.</p><p>I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025.</p><p><em>* Note that this conversation was recorded on July 11, 2025.</em></p><p></p><p> </p><div></div><p> </p> Wed, 16 Jul 2025 10:53:03 -0500 Legislation and Legislative Advocacy /advancing-health-podcast/2025-07-16-behind-bill-what-one-big-beautiful-bill-act-means-hospitals-and-health-systems <p>The passage of the One Big Beautiful Bill Act will present many policy changes and challenges for America's hospitals and health systems. In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with Rick Pollack, president and CEO of the ���������� Association, about the sweeping impacts this legislation will have in the health care field. They break down the $900 billion in Medicaid and ACA marketplace cuts, the real-world effects on communities, and the behind-the-scenes advocacy that helped blunt even deeper damage.</p><p>This podcast was recorded on July 11, 2025</p><hr><div></div><p> </p> Tue, 15 Jul 2025 23:50:34 -0500 Legislation and Legislative Advocacy /news/headline/2025-07-07-aha-supports-legislation-adding-14000-residency-slots-address-physician-shortages <p>The AHA July 2 expressed <a href="/lettercomment/2025-07-07-aha-supports-bipartisan-resident-physician-shortage-reduction-act">support</a> for the Resident Physician Shortage Reduction Act (H.R. 3890), bipartisan legislation that would add 14,000 Medicare-funded residency positions over seven years to help alleviate ongoing physician shortages. Sponsored by Reps. Terri Sewell, D-Ala., and Brian Fitzpatrick, R-Penn., the bill would direct the Centers for Medicare & Medicaid Services to increase the number of slots by 2,000 annually from 2026 through 2032. Additionally, the bill would authorize $63.5 million in grant funding for rural hospitals seeking to launch residency programs. Except for 1,200 slots created in 2021 and 2023, the number of Medicare-funded residency positions has been frozen since 1997.   <br> </p> Mon, 07 Jul 2025 16:16:28 -0500 Legislation and Legislative Advocacy /news/headline/2025-07-03-house-passes-final-version-one-big-beautiful-bill-act <p>The House July 3 <a href="https://www.congress.gov/bill/119th-congress/house-bill/1" target="_blank">voted</a> 218-214 to pass the final version of the <a href="https://sponsors.aha.org/rs/710-ZLL-651/images/07032025-Legis-language-h1_eas.pdf" target="_blank">One Big Beautiful Bill Act</a> (H.R. 1), which enacts many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. Reps Thomas Massie, R-Ky., and Brian Fitzpatrick, R-Penn., voted with House Democrats against the bill. The bill includes significant policy changes to Medicaid and the Health Insurance Marketplaces.</p><p>In a <a href="/press-releases/2025-07-03-aha-statement-house-passage-one-big-beautiful-bill-act" target="_blank">statement</a> shared with media July 3, AHA President and CEO Rick Pollack said, “Today is an extremely disappointing and very difficult day for health care in America. Despite months of clearly demonstrating the implications that these Medicaid proposals will have on the patients and communities we serve, especially the most vulnerable populations, Congress has enacted cuts of nearly a trillion dollars to the Medicaid program. No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage — cannot be simply dismissed as waste, fraud, and abuse. The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.</p><p>“The AHA remains committed to working with all stakeholders to mitigate the impact of these cuts wherever possible. Our goal is to help ensure hospitals can remain open for their communities, and people can get the care they need when they need it. Our nation’s health and economic future depend on it.”</p><p>Trump is expected to sign the bill into law July 4. The AHA will continue to update members on provisions in the bill and what to expect moving ahead.</p> Thu, 03 Jul 2025 15:03:34 -0500 Legislation and Legislative Advocacy