---
type: entity
entity_type: organization
name: One Big Beautiful Bill Act (OBBBA)
domain: health
status: enacted
founded: 2025-07-04
headquarters: United States
website: 
tags: [medicaid, healthcare-policy, budget-reconciliation, coverage-loss]
supports:
- OBBBA Medicaid work requirements destroy the enrollment stability that value-based care requires for prevention ROI by forcing all 50 states to implement 80-hour monthly work thresholds by December 2026
reweave_edges:
- OBBBA Medicaid work requirements destroy the enrollment stability that value-based care requires for prevention ROI by forcing all 50 states to implement 80-hour monthly work thresholds by December 2026|supports|2026-04-09
---

# One Big Beautiful Bill Act (OBBBA)

**Type:** Federal legislation (budget reconciliation)
**Status:** Enacted July 4, 2025
**Domain:** Healthcare policy, Medicaid reform

## Overview

The One Big Beautiful Bill Act (OBBBA) is budget reconciliation legislation signed July 4, 2025, that restructures Medicaid through work requirements, eligibility redeterminations, and provider tax restrictions. The Congressional Budget Office projects 10 million Americans will lose health coverage by 2034 as a result.

## Key Provisions

**Work Requirements:**
- 80 hours/month requirement for able-bodied adults ages 19-65
- Effective December 31, 2026
- CBO projects 5.3M uninsured by 2034 (largest single driver)

**Eligibility Redeterminations:**
- Semi-annual eligibility checks (every 6 months)
- Effective October 1, 2026
- CBO projects 700K additional uninsured

**Provider Tax Restrictions:**
- States prohibited from establishing new provider taxes
- Existing taxes frozen at current levels
- Expansion state provider taxes must reduce to 3.5% by 2032
- CBO projects 1.2M additional uninsured

**Expansion Incentive Elimination:**
- Effective January 1, 2026

**Additional Cost-Sharing:**
- For expansion adults, effective October 1, 2028

**Rural Health Transformation:**
- $50 billion program (FY 2026-2030)
- Grant-based, partially offsetting coverage losses

## Fiscal Impact

- $793 billion reduction in federal Medicaid spending over 10 years
- $990 billion total Medicaid and CHIP reductions combined
- $204 billion increase in uncompensated care costs

## Coverage Impact Timeline

- 2026: 1.3M uninsured
- 2027: 5.2M uninsured
- 2028: 6.8M uninsured
- 2029: 8.6M uninsured
- 2034: 10M uninsured
- Medicaid provisions account for 7.8M of 10M total

## Timeline

- **2025-07-04** — OBBBA signed into law
- **2025-07-24** — CBO releases final score projecting 10M coverage loss by 2034