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

2.5 KiB Raw Blame History