/ en Thu, 17 Jul 2025 20:35:37 -0500 Wed, 16 Jul 25 14:21:17 -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 Budget Reconciliation /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-b1887b81ea3812d9f6d22e9e11f9ad413dc614786d00437e559c04f892c66f9f"> <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="/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> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-03-house-passes-final-version-one-big-beautiful-bill-act" hreflang="en">House passes final version of One Big Beautiful Bill Act</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-03T15:03:34-05:00" title="Thursday, July 3, 2025 - 15:03">Jul 3, 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="/press-releases/2025-07-03-aha-statement-house-passage-one-big-beautiful-bill-act" hreflang="en">AHA Statement on House Passage of One Big Beautiful Bill Act</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-03T06:21:02-05:00" title="Thursday, July 3, 2025 - 06:21">Jul 3, 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/2025-07-02-house-begins-consideration-budget-reconciliation-bill-house-floor" hreflang="en">House begins consideration of budget reconciliation bill on to House floor </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-02T15:48:49-05:00" title="Wednesday, July 2, 2025 - 15:48">Jul 2, 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 Budget Reconciliation /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-705d1d2028a415e843e60885530d54b76badc4bc1e854672060e037269edc37a"> <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="/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> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-03-house-passes-final-version-one-big-beautiful-bill-act" hreflang="en">House passes final version of One Big Beautiful Bill Act</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-03T15:03:34-05:00" title="Thursday, July 3, 2025 - 15:03">Jul 3, 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="/press-releases/2025-07-03-aha-statement-house-passage-one-big-beautiful-bill-act" hreflang="en">AHA Statement on House Passage of One Big Beautiful Bill Act</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-03T06:21:02-05:00" title="Thursday, July 3, 2025 - 06:21">Jul 3, 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/2025-07-02-house-begins-consideration-budget-reconciliation-bill-house-floor" hreflang="en">House begins consideration of budget reconciliation bill on to House floor </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-02T15:48:49-05:00" title="Wednesday, July 2, 2025 - 15:48">Jul 2, 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 Budget Reconciliation /lettercomment/2025-07-16-aha-expresses-support-protect-medicaid-and-rural-hospitals-act <p>July 16, 2025 </p><p>The Honorable Josh Hawley<br>United States Senate<br>115 Russell Senate Office Building<br>Washington, DC 20510 </p><p>Dear Senator Hawley: </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) writes to express our appreciation for your leadership during the debate on the reconciliation package and offer support for your legislation, the Protect Medicaid and Rural Hospitals Act. If enacted, your legislation will help hospitals and communities mitigate the impact of the Medicaid reductions that were part of the recently enacted One Big Beautiful Bill Act (OBBBA; Public Law No: 119-21). </p><p>The Medicaid program provides services for 72 million Americans, and the OBBBA would reduce federal support for the program by nearly $1 trillion and cause many millions of people to lose access to health insurance. Among the law’s provisions are significant changes to how provider taxes and state directed payments (SDPs) will operate. Provider taxes and SDPs are important tools states use to ensure providers are more adequately reimbursed by a program that historically underpays them for the care they deliver to Medicaid patients. In 2023, Medicaid underpaid hospitals and health systems nationwide by $27.5 billion for treating program beneficiaries. SDPs also support hospital financial viability and allow them to offer essential services for Medicaid recipients, including labor and delivery and behavioral health care, which ultimately contributes to the wellbeing of everyone served by their local facility. The Congressional Budget Office estimates Sections 71115 and 71116 of the OBBBA would cut $340 billion in federal funding from the Medicaid program over the next 10 years. Your legislation strikes these two sections to mitigate the impact of Medicaid reductions on hospitals and health systems and allow them to continue to serve their patients and communities. </p><p>In addition, you build upon the provisions of the OBBBA that seek to assist rural hospitals, some of which are struggling to operate, even before the major policy changes of the OBBBA are enacted. The Protect Medicaid and Rural Hospitals Act provides for an additional $50 billion for the Rural Health Transformation program. These funds are a positive step toward mitigating some of the other Medicaid policy changes in the OBBBA that could negatively impact rural hospitals. </p><p>Thank you for your continued attention to the issues that affect America’s hospitals and health systems, and we look forward to working with you to increase support for your legislation. </p><p>Sincerely, </p><p>/s/ </p><p>Richard J. Pollack<br>President and Chief Executive Officer   </p> Wed, 16 Jul 2025 14:21:17 -0500 Budget Reconciliation /leadership-dialogue <div class="container"><div class="row"><div class="col-md-8"><img src="/sites/default/files/inline-images/leadership-dialogue-freese-decker-pollack-0725-900x400.jpg" data-entity-uuid="170fb397-8bd2-4b79-8863-d07fac49492d" data-entity-type="file" alt="Leadership Dialogue. A Conversation with AHA Chair Tina Freese Decker and AHA President and CEO Rick Pollack." width="900" height="400"><p>In early July, 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. This legislation will have a significant impact on hospitals and health systems as the changes are enacted.</p><p>In this episode, 2025 AHA Board Chair Tina Freese Decker talks with AHA President and CEO Rick Pollack about the legislation’s key provisions that apply to health care. Freese Decker and Pollack discuss how the AHA is helping the field prepare for some of the law’s changes, as well as ongoing efforts to mitigate some of the policies.</p><p>During the conversation, Freese Decker and Pollack 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 legislators about the real-world impact the policies they enact will have on patients and communities remain vital, and the conversation closes by exploring what this looks like for hospitals and health systems.</p><p>* <em>Note that this conversation was recorded on July 11, 2025.</em></p><hr><p></p><hr><div></div> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br>   </h2> </summary> <p> 00:00:01:04 - 00:00:32:24<br> Tom Haederle<br> Welcome to Advancing Health. Most experts agree that less reliance on foreign made medical and pharmaceutical products would be a good thing for U.S. health care. But experts also agree it's going to take some time to increase control over our supply chain. In today's podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the ���������� Association, we hear from two experts about the potential impact of the Trump administration's trade tariffs on our supply chain and what they could mean for patients and providers. </p> <p> 00:00:32:27 - 00:00:39:28<br> Tom Haederle<br> This podcast was recorded on May 15th. </p> <p> 00:00:40:00 - 00:01:04:17<br> Tina Freese Decker<br> Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and board chair for the ���������� Association. This month, we are diving into a topic that is top of mind for all of our leaders, not just in health care. It's tariffs. As our nation watches the changing tariff policy play out for those in the hospital field, there are serious considerations as it relates to our supply chain. </p> <p> 00:01:04:19 - 00:01:31:00<br> Tina Freese Decker<br> Every day at Corewell Health and I'm sure at every hospital health system across our country, we use a wide array of products, devices and pharmaceuticals to deliver safe and effective care to our communities. The lives of the people we serve often depend on these items being readily available, making a robust health care supply chain critical. While the field shares the administration's long term goal of strengthening the domestic supply chain for essential medical and pharmaceutical products, </p> <p> 00:01:31:03 - 00:01:57:00<br> Tina Freese Decker<br> we know that achieving this goal will require significant time. In the short term, there is concern that tariffs could inadvertently disrupt that availability of these essential care delivery products, increase the complexity of delivering patient care, and significantly raise hospital costs. So today, I'm joined by two guests who will help us better understand the current environment as it relates to tariffs and the potential implications to health care supply chain. </p> <p> 00:01:57:02 - 00:02:06:12<br> Tina Freese Decker<br> Brian Pomper is a partner at Akin Gump Strauss Hauer and Feld, a D.C. based law firm, and he specializes in international trade policy. Welcome, Brian. </p> <p> 00:02:06:19 - 00:02:07:05<br> Brian Pomper, JD<br> Thanks for having me. </p> <p> 00:02:07:20 - 00:02:24:28<br> Tina Freese Decker<br> Before joining Akin Gump, Brian formerly served as the chief international trade counsel to the Senate Finance Committee, where he advised of all aspects of the committee's international trade and economic agenda. So we'll get into some of your expertise today. And we are also joined by Akin Demehin. Welcome, Akin. </p> <p> 00:02:25:05 - 00:02:26:03<br> Akin Demehin<br> Thank you Tina. </p> <p> 00:02:26:05 - 00:02:54:05<br> Tina Freese Decker<br> Akin is AHA's vice president for quality and safety policy. He leads public policy analysis, development and advocacy efforts related to quality, patient safety and workforce on behalf of the ���������� Association. He also leads a regulatory policy development efforts related to the health care workforce. So thank you so much for joining us today. There's so many ups and downs, so many negotiations about what's happening with tariffs. </p> <p> 00:02:54:08 - 00:03:00:20<br> Tina Freese Decker<br> So Brian, I'm going to start with you. Can you tell us where we are today about what's happening for tariffs. </p> <p> 00:03:00:22 - 00:03:29:23<br> Brian Pomper, JD<br> Sure thing. Well there's a couple different avenues that the administration has taken on its trade and tariff plan, I'd say. The first I'd just talk about the giant reciprocal tariff regime that the president announced on Liberation Day, as he calls it, on April 2nd. On April 2nd, he announced that he would be imposing 10% tariffs on every country in the world and higher tariffs on 57 of those countries on April 9th. </p> <p> 00:03:29:23 - 00:03:53:27<br> Brian Pomper, JD<br> And so the 10% tariffs went into effect April 5th and then April 9th - for about a few hours - you had much higher tariffs on those 57 countries. The bond market and the stock market reacted quite negatively at the time. And so he decided he would pause those higher tariffs on the 57 countries for 90 days to allow for negotiations. </p> <p> 00:03:53:27 - 00:04:18:21<br> Brian Pomper, JD<br> He said at the time it was because the bond market had gotten, in his words, yippy. So they were watching what was happening in the broader market. Concerned about where the market was trending, decided to pause this enterprise to allow for these kind of bilateral negotiations over the course of 90 days. And so that's where we are now. Where there are, really, one hears 18 to 20 countries that are in active negotiations with the administration. </p> <p> 00:04:18:21 - 00:04:38:22<br> Brian Pomper, JD<br> There are many more that have proposed some degree of, measures they could take for their own economy. So there are really are dozens of countries that are engaged in negotiations with the United States during this 90 day period. There's been one announced agreement with the United Kingdom that was late last week or earlier this week. </p> <p> 00:04:38:24 - 00:04:58:07<br> Brian Pomper, JD<br> I would just note that that agreement with the U.K., it's much less of an operational agreement and much more really of a kind of a scoping exercise in agreement to agree sometime in the future on certain matters. And so it's really just a little bit of an appetizer for what maybe these agreements might look like in the future. </p> <p> 00:04:58:07 - 00:05:22:03<br> Brian Pomper, JD<br> And the hard part in even negotiating with the U.K. has yet to be done. There's a rumor that there's another agreement that should be announced here fairly soon, but I expect there will be a whole series of these kinds of announcements over the course of the next 90 days, until July 9th. I wouldn't expect the very high reciprocal tariffs on those 57 countries to snap back immediately into place on July 9th. </p> <p> 00:05:22:06 - 00:05:39:01<br> Brian Pomper, JD<br> My expectation is that countries that are able to negotiate, as the U.K. did, will end up with a 10% tariff. They won't get their higher tariff. But even for those countries that have expressed a willingness to negotiate with the United States, I don't think that the higher tariffs will go into place. I think the president will extend the pause there. </p> <p> 00:05:39:08 - 00:06:05:14<br> Brian Pomper, JD<br> So that's reciprocal tariffs. And then there are section 232 investigations. This is a mechanism whereby the president can ask the Department of Commerce to do an investigation into the national security impact of certain imports. And there has been, a variety of investigations that this president has, has undertaken and actually imposed tariffs on steel and aluminum and autos. All those tariffs are in place under the section 232 authority. </p> <p> 00:06:05:16 - 00:06:30:16<br> Brian Pomper, JD<br> But there's also investigations into pharmaceuticals, into semiconductors, trucks, timber, lumber, copper, aerospace, potentially more coming down the pike. And so we're expecting those investigations to be announced here in the coming months. But we don't know exactly where the president will land yet. The premise of those investigations is supposed to be the national security impacts of those imports. </p> <p> 00:06:30:18 - 00:06:52:20<br> Brian Pomper, JD<br> But really, the president seems to be using them as a cudgel to try to force companies to restore their manufacturing from overseas to the United States by tariffing the imports. He seems to like a tariff of 25%. That's the tariff that applies on steel, aluminum and autos. I think that's where we see him landing on some of these others. </p> <p> 00:06:52:23 - 00:07:26:13<br> Brian Pomper, JD<br> And unlike the reciprocal tariffs where there's a lot of negotiation that's ongoing, the section 232 tariffs feel a lot stickier. They'll be a lot harder to get out from underneath them. And then of course there are the China tariffs. When the president announced the 34% reciprocal tariff for China. China retaliated and we ended up in a tit for tat retaliation that ended up really with, 145% base tariff on imports into the United States from China and 125% tariff from US exports to China. </p> <p> 00:07:26:15 - 00:07:46:12<br> Brian Pomper, JD<br> That really was like an economic blockade. And both economies really needed to lower those and in fact, they did agree. The United States and China agreed to lower those tariffs. And so now the tariffs on products coming into China, the base tariff is 30% plus whatever additional tariffs might apply. And from the US side into China, it's 10%. </p> <p> 00:07:46:15 - 00:08:02:28<br> Tina Freese Decker<br> I was just recently reading a book, history book and talked about tariffs. So can you share how tariffs have been handled differently compared in the past, how they are different today than they were used in past administrations or past years and strategies? </p> <p> 00:08:03:00 - 00:08:26:03<br> Brian Pomper, JD<br> Yeah. Thank you. I love this question. Allows me to bring out my inner professor. So I would say for the first 150 years of American history, there was no topic that was more often and more frequently debated in Congress than what should be the level of the tariff. You had the incipient industrial industries in the North that wanted higher tariffs to protect their growing power up there. </p> <p> 0:08:26:05 - 00:08:49:15<br> Brian Pomper, JD<br> And then you had growers in the South who wanted open export markets, and so they wanted low tariffs so that other countries don't go there. So there was this just constant negotiation. We ended in 1930 with something called the Smoot-Hawley tariff, which people may remember from their high school history class, as blamed for having deepened the Great Depression, I think widely perceived as a negative economic outcome. </p> <p> 00:08:49:17 - 00:09:10:10<br> Brian Pomper, JD<br> And since 1930, what the Congress has really done is to delegate to the president quite a bit of authority over trade policy. This is why we have things like the section 232 investigation, where Congress has understood that well, you know, maybe it's not the best use of congressional time to negotiate on what the tariff on salmon imports should be. </p> <p> 00:09:10:13 - 00:09:33:18<br> Brian Pomper, JD<br> You know, we're going to let the president kind of deal with that stuff. So we have for the last almost 100 years, had this kind of joint authority between Congress and the president where they would share this, this sort of responsibility. And I think there are those who will argue that that President Trump is using this authority in ways that hadn't been contemplated. </p> <p> 00:09:33:20 - 00:09:56:17<br> Brian Pomper, JD<br> In particular, I would say, with a line of tariffs that I didn't talk about, which are these tariffs under the International Emergency Economic Powers Act that were imposed on Canada and Mexico, also on China. And actually, I should say IEEPA is the underlying authority the president used for this entire reciprocal tariff regime. It is a very aggressive use of this authority. </p> <p> 00:09:56:20 - 00:10:17:18<br> Brian Pomper, JD<br> That that's unusual. The president is much more willing to push legal boundaries, of course, not just in tariffs, but we certainly see it in tariffs here. So much so it is currently being challenged in the courts. And it's really anybody's guess whether the courts are going to decide that he may have exceeded his authority under the IEEPA statute to him to impose these tariffs. </p> <p> 00:10:17:21 - 00:10:19:28<br> Tina Freese Decker<br> And can you explain the IEEPA statute? </p> <p> 00:10:20:01 - 00:10:43:18<br> Brian Pomper, JD<br> Sure. I'm happy to. So IEEPA stands for the International Emergency Economic Powers Act. It was passed in 1977 to allow the president to act quickly in cases of some sort of economic emergency. It's actually the basis for our entire export controls regime. It has never been used before to impose tariffs. President Trump is the first president to use it to impose tariffs. </p> <p> 00:10:43:21 - 00:11:08:13<br> Brian Pomper, JD<br> There was a predecessor statute called the Trading With the Enemy Act, that President Nixon used to impose tariffs when we were in the process of going off of the gold standard, because there was a balance of payments crisis at the time. That was challenged in the courts, and the court at the time decided that was okay because the court decided, well, those tariffs that the president imposed were really in response to a true economic crisis. </p> <p> 00:11:08:13 - 00:11:32:19<br> Brian Pomper, JD<br> There wasn't enough gold in Fort Knox to cover the number of dollars that were in circulation at the time. And those tariffs were imposed for a relatively short period. It was only four months. And it wasn't every country and every product. If you fast forward now to the successor statute, the IEEPA statute, which was written largely because the Trading With the Enemy Act...it was an awkward fit for some of these actions that President Nixon took. </p> <p> 0:11:32:21 - 00:11:59:07<br> Brian Pomper, JD<br> Here you now have a president who has used IEEPA to impose tariffs on every country, every product, effectively forever. And so the question that the court in Yoshida, which is the case I'm talking about, the court in Yoshida decided the president in that case was not seeking to usurp the role of Congress, which is clearly given to Congress in the Constitution to control international economic relations, trade with foreign nations. </p> <p> 00:11:59:10 - 00:12:30:11<br> Brian Pomper, JD<br> The president wasn't seeking to stand in the role of Congress in resetting tariffs, because it was only time limited and, you know, limited in coverage. Here it's a much different circumstance where you really do have the entirety of the harmonized tariff code that covers all of our trade with every country being reset through executive order. I do think that there are very strong legal arguments that will be made and are being made in court, literally right now as we speak, that the president exceeded his authority under </p> <p> 00:12:30:14 - 00:12:40:06<br> Brian Pomper, JD<br> IEEPA. So it's not inconceivable in the next few weeks, you could see a court order that would invalidate the president's actions and really get rid of this entire reciprocal tariff regime. </p> <p> 00:12:40:08 - 00:13:04:03<br> Tina Freese Decker<br> Thank you very much. That was an excellent summary, we really appreciate that. I'm going to switch to Akin. Akin, can you share an overview of concerns specific to hospitals as how it relates to the tariffs may impact access to pharmaceuticals, medical supplies, other needed devices, and do you think that there is going to be a concern about exasperate some of the shortages that we have experienced to date? </p> <p> 00:13:04:06 - 00:13:27:02<br> Akin Demehin<br> Absolutely. I think the complexity that Brian was talking about in terms of how these tariffs are being rolled out is really needing the complexity of the health care supply chain. And the concern that we hear from members and that we really put front and center in our own advocacy efforts is what does this mean for the delivery of patient care? </p> <p> 00:13:27:04 - 00:13:54:21<br> Akin Demehin<br> What does it mean for our caregivers in health care facilities? Hospitals and health systems are constantly weaving together both domestic and international sources for their drugs, for their medical devices, and for other critical supplies. And we know that even temporary disruptions to the flows of those goods can have significant impacts to how hospitals deliver care. Great example are cancer drugs. 00:13:54:24 - 00:14:20:02<br> Akin Demehin<br> Many of those are manufactured in China or rely on a significant number of key starting materials that are manufactured in China or in other locations across the globe. The disruption from tariffs could potentially lead to disruptions in those carefully planned cancer treatments that really rely on careful scheduling. The same thing is true of things like cardiovascular medicines. </p> <p> 00:14:20:04 - 00:14:57:21<br> Akin Demehin<br> As you raised at the outset, Tina, we certainly support ongoing efforts to onshore production and really strengthen the domestic supply chain. At the same time, even those medical goods and devices that are manufactured here in the U.S. often draw in content from abroad. Great example is an infusion pump, where even those infusion pumps are manufactured here in the US might have parts from 20 or more different countries, ranging from the aluminum that goes into manufacturing the pole to the computer chips to the plastics. </p> <p> 00:14:57:24 - 00:15:12:17<br> Akin Demehin<br> All of that involves a considerable amount of complexity. And switching sourcing and offshoring production really is a long term effort. So we've really tried to elevate those concerns in our work around tariffs. </p> <p> 00:15:12:19 - 00:15:19:09<br> Tina Freese Decker<br> So can you tell us what the ���������� Association is doing to secure exemptions for medical devices and pharmaceuticals? </p> <p> 00:15:19:11 - 00:15:56:23<br> Akin Demehin<br> Sure. So early in the rollout of the tariffs from the administration - going back to early February - we actually sent a letter to the president outlining our concerns about the potential impacts of tariffs to the delivery of patient care, to our ability to provide things like personal protective equipment to frontline providers. And we've continued to follow that up with ongoing proactive dialogue with the administration to really focus on advocating for exemptions for pharmaceutical products and for medical devices. </p> <p> 00:15:56:25 - 00:16:27:12<br> Akin Demehin<br> Bryan talked about the section 232 investigations. The administration has one ongoing for pharmaceutical products, and had an opportunity for the field to share feedback. And we share our concerns with the administration and continue to ask for exemptions. The other thing that we are trying to do is to really provide the hospital and health system perspective to policymakers, to the media, to the administration. </p> <p> 00:16:27:14 - 00:16:51:22<br> Akin Demehin<br> We're in a bit of a unique position versus other kinds of fields where we are large consumers of the goods within the supply chain. Our ability to stockpile any of these supplies is often constrained by just the sheer availability of the supplies. The shelf life for things like pharmaceuticals is finite, so it's not necessarily something that you can just have hanging out on a shelf. </p> <p> 00:16:51:25 - 00:17:20:12<br> Akin Demehin<br> There's space that you have to have in order to warehouse some of these materials. And the way that hospitals and health systems are reimbursed means that it's really our members that bear the costs of tariffs. Because our rates are set by government and by contracts in the private sector, the potential cost impacts of tariffs are ones that we really feel quite directly for our members. </p> <p> 00:17:20:14 - 00:17:33:17<br> Tina Freese Decker<br> Akin, you answered all of my questions coming through there. That was fantastic, because those are all of the concerns that we have as members and what's going on. Brian, do you think that exemptions are likely knowing this administration? </p> <p> 00:17:33:19 - 00:17:54:18<br> Brian Pomper, JD<br> An excellent question I get from many, many clients. And I would go back to what I mentioned earlier. My expectation is that the American economy is going to struggle a bit under the weight of all of the tariffs that the president has imposed in all these ways. And there are more tariffs coming under these section 232 investigations that are currently ongoing. </p> <p> 00:17:54:20 - 00:18:27:09<br> Brian Pomper, JD<br> I think that many in Congress, especially on the Republican side, have expressed privately but not publicly concern about the president's strategy with respect to tariffs and how it might impact their constituents. But I think over time, the political and economic pressure is going to force some kind of adjustment in the administration. And I think the most logical pressure valve to be released for the administration is for them to reimpose some type of exclusion process, as we did have in the first administration. </p> <p> 00:18:27:09 - 00:18:33:15<br> Brian Pomper, JD<br> So if I'm a betting person, yes, I think we will have some kind of exclusion process. </p> <p> 00:18:33:18 - 00:18:54:27<br> Tina Freese Decker<br> We'll come back to see if you're right. And so to close out our conversation today, this has been really helpful, a great history lesson and understanding of what's going on. Brian and Akin, can you share with us what your advice would be for our members? What should we be thinking about doing, planning for, as we think about these tariffs and the impact that they have? </p> <p> 00:18:54:29 - 00:19:13:08<br> Brian Pomper, JD<br> Yeah, I always tell clients if something is important to you, important to your bottom line, you need to be vocal about it, and you need to be telling people how these measures are going to impact you. It's hard to argue with the goal, or at least one of the goals the president has of increasing manufacturing employment in the United States. </p> <p> 00:19:13:08 - 00:19:34:21<br> Brian Pomper, JD<br> Who doesn't want that? I think where there's debate is how best to achieve that. But I do think it's important for organizations like AHA to go talk to your members, talk to the people who focus on the policy issues, the policy areas that you deal with. Let them know how these tariffs are going to impact you, and ask them to weigh in on your behalf. </p> <p> 00:19:34:21 - 00:19:46:01<br> Brian Pomper, JD<br> And just make sure that whatever the administration does, they try to maximize benefit while minimizing harm. So I would just say where there's an opportunity to engage, I encourage the AHA to do so. </p> <p> 00:19:46:04 - 00:19:50:13<br> Tina Freese Decker<br> Maximize benefit and minimize harm. Great statement. Akin? </p> <p> 00:19:50:15 - 00:20:20:02<br> Akin Demehin<br> You know, Brian's counsel here is extremely wise. I'll just build on it in a couple of ways. One of the things that I know hospitals and health systems are so good at doing is bridging that gap between data and story. And often it is those stories of what's happening on the ground, how the steps that you go through to access supplies to deliver care, how those are affected, and playing that out for what it means for patients. </p> <p> 00:20:20:04 - 00:20:49:15<br> Akin Demehin<br> Those are the kinds of stories that I know policymakers respond to. It really makes the issue even more real for them. And as Brian alluded to, raising some of those concerns with policymakers and certainly reaching out to us here at AHA, we can always be strong advocates on your behalf when we have intel and stories, and other information from all of you to help make the case as best we can. </p> <p> 00:20:49:16 - 00:20:58:17<br> Akin Demehin<br> So we want to stay connected as we possibly can with all of you going forward so that we can push for those exemptions for pharmaceuticals and medical devices. </p> <p> 00:20:58:19 - 00:21:23:02<br> Tina Freese Decker<br> That's wonderful. And your example about the cancer drugs or the smart pump or MRI and how all of those pieces come together is one of those stories that we can talk about and how it impacts us. So Brian and Akin, thank you so much for your time today and sharing in your expertise. I know this is an evolving issue and the AHA will continue to monitor closely and advocate on behalf of our field. </p> <p> 00:21:23:04 - 00:21:29:13<br> Tina Freese Decker<br> And thank you to everyone tuning in today. We'll be back next month for another Leadership Dialogue conversation. </p> <p> 00:21:29:15 - 00:21:37:26<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details> </div> --></div><div class="col-md-4"><div class="views-element-container"> <section class="top-level-view js-view-dom-id-c5f562dbedf763d50a6921dfed7c7d4c69dfcab70a64cec95f294a197c6c8995 resource-block"> <h2>Previous Leadership Dialogues and Rounds</h2> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-06-30-chair-file-leadership-dialogue-legal-advocacy-protect-hospitals-aha-general-counsel-chad" hreflang="en">Chair File: Leadership Dialogue — Legal Advocacy to Protect Hospitals With AHA General Counsel Chad Golder</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-06-30T09:55:49-05:00">Jun 30, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-05-27-chair-file-leadership-dialogue-tariffs-and-health-care-brian-pomper-and-akin-demehin" hreflang="en">Chair File: Leadership Dialogue — Tariffs and Health Care with Brian Pomper and Akin Demehin</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-05-27T10:11:08-05:00">May 27, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-04-28-chair-file-leadership-dialogue-cybersecurity-health-care-john-riggi-ahas-national-advisor" hreflang="en">Chair File: Leadership Dialogue — Cybersecurity in Health Care with John Riggi, AHA’s National Advisor for Cybersecurity and Risk</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-04-28T11:46:47-05:00">Apr 28, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-03-31-chair-file-leadership-dialogue-importance-advocacy-and-storytelling-rural-health-lori" hreflang="en">Chair File: Leadership Dialogue — Importance of Advocacy and Storytelling in Rural Health with Lori Wightman, R.N., CEO of Bothwell Regional Health Center</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-03-31T10:49:30-05:00">Mar 31, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-02-24-chair-file-leadership-dialogue-advancing-health-and-building-trust-lynn-hanessian-and-robert" hreflang="en">Chair File: Leadership Dialogue — Advancing Health and Building Trust with Lynn Hanessian and Robert Trestman, M.D.</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-02-24T08:21:34-06:00">Feb 24, 2025</time> </span> </div></div> </div> </div> <div class="more-link"><a href="/topics/leadership-dialogue">Watch More Leadership Dialogues and Rounds Videos</a></div> </section> </div> </div></div></div> Wed, 16 Jul 2025 11:45:00 -0500 Budget Reconciliation /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 Budget Reconciliation /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 Budget Reconciliation /press-releases/2025-07-03-aha-statement-house-passage-one-big-beautiful-bill-act <div class="container"><div class="row"><div class="col-md-8"><h2>Rick Pollack<br>President and CEO<br>���������� Association<br> </h2><h2>July 3, 2025</h2><p>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>###</p></div><div class="col-md-4"><p> </p></div></div></div> Thu, 03 Jul 2025 06:21:02 -0500 Budget Reconciliation /news/headline/2025-07-02-house-begins-consideration-budget-reconciliation-bill-house-floor <p>The House has begun consideration of the Senate-passed version of the <a href="https://www.congress.gov/amendment/119th-congress/senate-amendment/2360/text" title="OBBBA">One Big Beautiful Bill Act (H.R. 1)</a>. This continues to be a fluid process in the House as Republican Leadership works to address lingering concerns about the bill. The Senate passed the bill <a href="/news/headline/2025-07-01-senate-passes-one-big-beautiful-bill-act" title="senate passage">yesterday</a> by a 51-50 tally, with Vice President J.D. Vance casting the tie-breaking vote. The AHA will release additional information on the bill as it progresses through the House.</p> Wed, 02 Jul 2025 15:48:49 -0500 Budget Reconciliation /news/headline/2025-07-01-senate-passes-one-big-beautiful-bill-act <p>The Senate narrowly <a href="https://www.senate.gov/legislative/LIS/roll_call_votes/vote1191/vote_119_1_00372.htm">passed</a> the <a href="https://www.congress.gov/bill/119th-congress/house-bill/1">One Big Beautiful Bill Act (H.R. 1)</a> on July 1 by a 50-50 tally, with Vice President J.D. Vance casting the tie-breaking vote. The Senate version of the bill now goes back to the House for consideration as Congress attempts to meet President Trump’s July 4 deadline. <br><br>The July 1 Senate vote followed a lengthy “vote-a-rama" on proposed amendments that lasted more than 24 hours. An amendment from Sen. Rick Scott, R-Fla., was withdrawn during the process that would have required, in expansion states, that any Medicaid beneficiary who temporarily lost coverage and reapplied to be enrolled at the traditional Medicaid Federal Medical Assistance Percentage.<br><br>Despite the withdrawn amendment, the Senate bill still contained provisions that would make greater cuts to Medicaid than the initial bill passed by the House.<br><br>In a <a href="/press-releases/2025-07-01-aha-statement-senate-passage-one-big-beautiful-bill-act">statement</a> shared with media, AHA President and CEO Rick Pollack said, “We are deeply disappointed by today’s vote in the United States Senate to advance the One Big Beautiful Bill Act (H.R. 1). The real-life consequences of these nearly $1 trillion in Medicaid cuts – the largest ever proposed by Congress – will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients. <br><br>“This legislation will cause 11.8 million Americans to be displaced from their health care coverage as they move from insured to uninsured status. It also will drive up uncompensated care for hospitals and health systems, which will affect their ability to serve all patients. It will force hospitals to make service line reductions and staff reductions, resulting in longer waiting times in emergency departments and for other essential services, and could ultimately lead to facility closures, especially in rural and underserved areas.</p><p>We urge the House to mitigate this legislation and protect access to health care for patients and communities.” <br><br>The House Rules Committee is <a href="https://rules.house.gov/media/videos/rules-committee-hearing-senate-amendment-hr-1-0">meeting</a> July 1 to begin preparing the bill for floor consideration. </p> Tue, 01 Jul 2025 15:41:50 -0500 Budget Reconciliation