teleo-codex/entities/health/one-big-beautiful-bill-act.md
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2026-04-04 14:00:16 +00:00

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type entity_type name domain status founded headquarters website tags
entity organization One Big Beautiful Bill Act (OBBBA) health enacted 2025-07-04 United States
medicaid
healthcare-policy
budget-reconciliation
coverage-loss

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