/ en Fri, 18 Jul 2025 01:59:48 -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 One Big Beautiful Bill Act (OBBBA) /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 One Big Beautiful Bill Act (OBBBA) /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 One Big Beautiful Bill Act (OBBBA) /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 One Big Beautiful Bill Act (OBBBA) /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 One Big Beautiful Bill Act (OBBBA) /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 One Big Beautiful Bill Act (OBBBA) /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 One Big Beautiful Bill Act (OBBBA) /action-alert/2025-07-01-senate-passes-budget-reconciliation-bill-house-expected-vote-week <div class="container"><div class="row"><div class="col-md-8"><p>The Senate today voted 51 to 50, with a deciding vote by Vice President J.D. Vance, to pass its version of the <a href="https://sponsors.aha.org/rs/710-ZLL-651/images/Alert-07012025_FILE_0958.pdf?version=0">budget reconciliation bill</a>. Republican Sens. Susan Collins, R-Maine, Rand Paul, R-Ky., and Thom Tillis, R-N.C., voted against the final passage. The One Big Beautiful Bill Act (OBBBA) contains drastic cuts to the Medicaid program, among other provisions that impact the health care field. The AHA continues to make the case to lawmakers for mitigation as the bill moves through the budget reconciliation process and will provide members with critical updates.</p><p>AHA President and CEO Rick Pollack said in a statement sent to the media, “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.</p><p>“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.”</p><p>The AHA successfully advocated against an amendment from Sen. Rick Scott, R-Fla. Sen. Scott last night withdrew his amendment, which, starting in 2031, would have reduced the Federal Medical Assistance Percentage (FMAP) paid to states that have expanded their Medicaid programs and would have led to a reduction of Medicaid payments to hospitals by $99.2 billion over five years.</p><p>It is anticipated that the House and Senate will not elect to pursue a conference on the bill; therefore, the House is poised to take up the Senate version of the OBBBA. The House Committee on Rules is meeting today to establish the terms and conditions of debate for the vote. House leadership plans to move the bill to the floor tomorrow and hold a vote this week to send the bill to the president for signature by the July 4 holiday.</p><p>The following are highlights of key changes from the <a href="/advisory/2025-06-28-senate-releases-legislative-text-substitute-hr1-one-big-beautiful-bill-act">original text</a> to the OBBBA as passed by the Senate. The AHA will provide a full summary of key provisions impacting the hospital field once the bill is enacted.</p><h2>Key Changes in the OBBBA</h2><ul><li><strong>Provider taxes (Section 71115). </strong>Amends language to include provider taxes levied by units of local government, in addition to states. Additionally, the legislation increases the amount of implementation funding available to the Centers for Medicare & Medicaid Services (CMS) administrator to $20 million for fiscal year (FY) 2026.</li><li><strong>State-directed payments (Section 71116). </strong>Adds language clarifying that completed preprints for payments can be submitted until enactment and may be grandfathered in at a temporarily higher rate, in addition to those already approved by the Health and Human Services Secretary. Amends the definition<strong> </strong>of the total published Medicare payment rate to the definition provided in section 438.6(a) of title 42 of the Code of Federal Regulations or any future regulation that replaces it.</li><li><strong>Rural health transformation program (Section 71401). </strong>Increases the funds available in the rural stabilization fund to $50 billion, to be paid out as $10 billion annually across FYs 2026 through 2030 (two years earlier).</li><li><strong>Modifying cost-sharing requirements for Medicaid expansion enrollees (Section 71120). </strong>Appropriates $15 million to the CMS administrator for FY 2026 to implement the provision.</li><li><strong>Expansion FMAP for emergency Medicaid (Section 71110). </strong>Appropriates $1 million to the CMS administrator for FY 2026 to implement the provision.</li></ul><h2>Provisions No Longer Included in the OBBBA</h2><ul><li><strong>Expansion of FMAP for certain states providing payments for health care services furnished to certain individuals (formerly Section 71111).</strong> Would have lowered the Medicaid expansion FMAP from 90% to 80% for states that choose to provide coverage using the state’s funds to people who are undocumented.</li><li><strong>Prohibiting federal Medicaid and CHIP funding for certain items and services (formerly Section 71114).</strong> Would have prohibited federal Medicaid or CHIP funds from being spent on specified items and services for gender transition purposes.</li><li><strong>Determination of FMAP for high-poverty states (formerly Section 71124).</strong> Would have provided an enhanced FMAP match for certain “high-poverty states” determined annually.</li><li><strong>Application of cost-of-living adjustment to the non-labor-related portion for hospital outpatient department services furnished in Alaska and Hawaii (formerly Section 71204). </strong>Would have provided a cost-of-living adjustment to the non-labor-related portion of hospital outpatient payments in Alaska and Hawaii.</li></ul><h2>Resources</h2><p>The AHA has developed myriad resources for member use. Visit the <a href="/advocacy/advocacy-issues/medicaid">Medicaid Issues page</a> and the <a href="/advocacy/action-center">AHA Action Center</a> for the latest tools and resources.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/07/senate-passes-budget-reconciliation-bill-house-expected-to-vote-this-week-alert-7-1-2025-f.pdf"><img src="/sites/default/files/2025-07/cover-senate-passes-budget-reconciliation-bill-house-expected-to-vote-this-week-alert-7-1-2025.png" data-entity-uuid data-entity-type="file" alt="Action Alert: Senate Passes Budget Reconciliation Bill; House Expected to Vote This Wee" width="NaN" height="NaN"></a></div></div></div> Tue, 01 Jul 2025 13:17:55 -0500 One Big Beautiful Bill Act (OBBBA) /press-releases/2025-07-01-aha-statement-senate-passage-one-big-beautiful-bill-act <p class="text-align-center"><strong>Rick Pollack</strong><br><strong>President and CEO</strong><br><strong>���������� Association</strong></p><p class="text-align-center"><strong>July 1, 2025</strong></p><p>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.</p><p>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. </p><p> </p><p class="text-align-center">###</p> Tue, 01 Jul 2025 11:16:29 -0500 One Big Beautiful Bill Act (OBBBA) /special-bulletin/2025-07-01-senator-scotts-amendment-withdrawn-senate-vote <div class="container"><div class="row"><div class="col-md-8"><p>Sen. Rick Scott, R-Fla., has withdrawn his amendment to the Senate’s budget reconciliation bill. This withdrawal comes after a vigorous advocacy campaign by the AHA, with the great assistance of our members, to urge senators to vote no on the amendment. Thanks to our unified effort, this harmful policy will not be included in the Senate’s version of the budget reconciliation bill.</p><p>The amendment would have required, in expansion states, that any Medicaid beneficiary who temporarily loses coverage and reapplies would be enrolled at the traditional Medicaid Federal Medical Assistance Percentage. In addition, the amendment would have required that only Medicaid expansion enrollees who were “grandfathered” (those enrolled as of Dec. 31, 2030) could receive the enhanced match. <a href="/fact-sheets/2025-06-29-estimated-impact-fmap-reduction-90-traditional-result-churn-federal-medicaid-hospital-spending">AHA analysis</a> showed that the impact of the amendment would have been a reduction of Medicaid payments to hospitals by $99.2 billion over five years.</p><p>The Senate is finishing the reconciliation process vote-a-rama, where unlimited amendments can be presented prior to the final vote. There will also be a process for a final amendment that could provide the opportunity for additional changes. The Senate bill will be sent back to the House for their final vote.</p><p>The AHA continues to monitor the progress of the budget reconciliation process and will provide members with critical updates.</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"><p><a href="/system/files/media/file/2025/07/Special-Bulletin-Senator-Scotts-Amendment-Withdrawn-from-Senate-Vote.pdf" target="_blank" title="Click here to download the Special Bulletin: Senator Scott’s Amendment Withdrawn from Senate Vote PDF."><img src="/sites/default/files/inline-images/Special-Bulletin-Senator-Scotts-Amendment-Withdrawn-from-Senate-Vote.png" data-entity-uuid="089c23c5-d875-45ad-b8b5-9a4accf80210" data-entity-type="file" width="698" height="900"></a></p></div></div></div> Tue, 01 Jul 2025 09:30:00 -0500 One Big Beautiful Bill Act (OBBBA)