How The Big Beautiful Bill Will Impact Doctors And The Healthcare Industry

President Trump signed his signature domestic policy legislation, the “One Big Beautiful Bill,” into law on July 4, 2025. This sweeping 887-page measure represents one of the most significant changes to American healthcare policy in decades, extending tax cuts while dramatically reshaping Medicaid and other health programs.

The legislation passed the House in a narrow 218-214 vote after the Senate approved it 51-50, with Vice President JD Vance casting the tie-breaking vote. At its core, the bill makes permanent most provisions of the 2017 Tax Cuts and Jobs Act while implementing substantial cuts to health and nutrition programs.

Understanding the ‘Big Beautiful Bill’

The legislation combines tax policy with major healthcare reforms, funded primarily through reductions in federal health spending. The Congressional Budget Office estimates the bill will add $3.4 trillion to federal deficits over the next decade while leaving approximately 11.8 million Americans without health insurance by 2034.

Medical organizations across the country have condemned the healthcare provisions. Dr. Jason Goldman, president of the American College of Physicians, stated the Medicaid cuts “will have devastating consequences for the American health care system and the health of the American public.”

Major Changes to Medicaid

The bill implements the most significant changes to Medicaid since the program’s creation nearly 60 years ago.

Work Requirements

For the first time in Medicaid’s history, certain able-bodied adults aged 19-64 must work, participate in job training, volunteer, or attend school for at least 80 hours monthly to maintain benefits. This requirement also applies to parents of children 14 and older.

Funding Cuts

Federal Medicaid support will be reduced by $930 billion over the next decade. The legislation also phases down provider taxes that states use to fund their portion of Medicaid costs, lowering them from 6% to 3.5% by 2032.

Eligibility Changes

The bill requires more frequent eligibility checks, making it harder for beneficiaries to maintain continuous coverage. These combined changes are projected to result in millions losing Medicaid coverage.

Impact on Healthcare Access

Healthcare experts warn the changes will create a domino effect throughout the medical system.

Emergency Room Strain

Arthur Caplan, a medical ethics professor at NYU Grossman School of Medicine, explained that patients losing coverage won’t simply disappear. “They will end up in emergency rooms, further straining an already stressed system,” he said. “All of these people who are getting dropped… they go to the ER and they sit there with their headache, or kid with a cough, or chest pain.”

Rural Hospital Concerns

Rural hospitals, which typically operate on thin profit margins and rely heavily on Medicaid payments, face particular challenges. The legislation includes a $50 billion rural hospital stabilization fund, but experts question whether this adequately addresses the funding shortfall.

Healthcare Workforce Impact

The bill includes a temporary 2.5% increase to the Medicare Physician Fee Schedule for 2026, intended to help physician practices facing “exceptional circumstances.” However, the American Osteopathic Association notes this increase is temporary and doesn’t address long-term payment system instability.

Changes to the Affordable Care Act

The legislation also modifies the Affordable Care Act in ways projected to reduce enrollment.

Enrollment Process Changes

Policyholders can no longer automatically re-enroll in ACA plans. Instead, they must update their information annually during a shortened open enrollment period that ends about a month earlier than before.

Subsidy Processing

Anyone applying for ACA coverage outside the open enrollment period must wait for complete documentation processing before receiving government subsidies. Previously, applicants could receive 90 days of premium assistance while applications were pending.

Reproductive Health Services

The bill includes provisions that will significantly impact reproductive healthcare access. It defunds Planned Parenthood by making the organization ineligible to serve Medicaid patients. According to the Contraceptive Access Initiative, 10% of women on Medicaid who received family planning services in 2021 did so at Planned Parenthood locations.

Food Security Programs

The legislation also affects nutrition assistance programs. It raises the age requirement for able-bodied adults to qualify for SNAP benefits from 54 to 64, with limited exceptions for parents of young children. The bill also shifts some SNAP costs to states with high error rates.

Limited Positive Provisions

Despite widespread criticism, the bill includes some provisions healthcare advocates view favorably.

Telehealth Expansion

The legislation makes permanent certain telehealth flexibilities, including first-dollar coverage for High-Deductible Health Plan-Health Savings Accounts.

Reimbursement Increases

The bill increases reimbursement rates for healthcare providers in the 40 states that have expanded Medicaid, though this doesn’t apply to non-expansion states.

Looking Ahead: What This Means for Patients

The implementation of these changes will unfold over the coming years, with full effects expected by 2034. Healthcare professionals and patients should prepare for:

• Increased administrative burdens related to Medicaid eligibility verification
• Potential disruptions in coverage for vulnerable populations
• Greater strain on emergency departments and safety-net providers
• Changes in how healthcare organizations manage their finances

Preparing for the Changes

Healthcare organizations and patients affected by these changes should begin planning now. This includes understanding new eligibility requirements, preparing for potential coverage gaps, and exploring alternative coverage options.

As these provisions take effect, the full impact on America’s healthcare system will become clearer, but early projections suggest significant challenges ahead for both patients and healthcare providers.