The One Big Beautiful Bill Act (OBBBA) is best known as a sweeping tax and spending law, but also includes many healthcare provisions that are already reshaping how Americans access and pay for care. Many of the bill’s provisions will phase in over the next few years, so its full impact has yet to be seen. That said, the Congressional Budget Office estimates that the law’s Medicaid provisions alone will increase the uninsured population by 7.5 million in 2034.
The expected impact of OBBBA varies considerably from person to person, depending on age, income, employment, immigration status, state of residence, and many other factors. Here’s a look at what the key changes are, how they’re expected to affect patients and providers, and what healthcare organizations can do to prepare.
What OBBBA means for healthcare
Medicaid
Beginning in 2027, many low-income adults covered through the Affordable Care Act’s Medicaid expansion will have to prove they’ve worked, volunteered, studied, or performed another qualifying activity for at least 80 hours a month. In addition, these enrollees will be subject to more stringent and frequent eligibility checks.
The law shortens the period of retroactive Medicaid coverage, meaning patients may be left responsible for more medical bills incurred before they applied for coverage, starting in 2027. And come October 2028, some Medicaid enrollees will face new out-of-pocket charges for certain services.
The law also restricts the tools states use to finance Medicaid and get federal matching funds. Starting in 2028, states will be prohibited from creating or increasing certain taxes on healthcare providers and, in Medicaid-expansion states, will need to gradually reduce how much they collect through some existing provider taxes. The law will also cap supplemental payments that states direct Medicaid managed-care plans to make to hospitals and certain other providers and tighten financing rules for some Medicaid waiver programs.
ACA Marketplace coverage
In 2026, OBBBA ended eligibility for federally subsidized Marketplace coverage for some lawfully present immigrants. In addition, people who receive more subsidy than their final annual income entitles them to must now repay the full excess amount at tax time. OBBBA also expanded access to catastrophic plans, which generally come with lower monthly premiums but much higher deductibles.
Other changes will take effect in future years. Beginning with 2028 coverage, people seeking subsidized Marketplace insurance will face stricter verification requirements and generally will need to actively confirm their information each year instead of relying on automatic reenrollment.
Separately, Congress allowed temporary enhancements to ACA premium tax credits to expire at the end of 2025. As a result, many Marketplace enrollees now receive less help paying their premiums, although that change was not created by OBBBA.
Medicare
As of 2026, some refugees, asylees, and people with Temporary Protected Status are ineligible for Medicare due to OBBBA. In addition, the law allows more drugs used to treat rare diseases to avoid or delay Medicare price negotiation.
OBBBA also temporarily increased Medicare physician payments by 2.5% for services provided, although this boost only runs until the end of 2026.
HSAs and employer-related benefits
As of 2026, OBBBA broadened HSA eligibility and permitted uses, as well as HSA eligibility for certain bronze and catastrophic plans. It also raised the dependent-care FSA limit to $7,500.
Provider-specific changes
Restrictions on federal Medicaid payments to certain reproductive-health providers took effect when the law was enacted in 2025, but expired after a year on July 4, 2026.
In 2026, OBBBA began funding a $50 billion Rural Health Transformation Program, a temporary federal grant program for states to go toward projects intended to make rural care more accessible and sustainable, although these additional funds are not expected to fully offset the broader Medicaid cuts or replace all of the revenue rural hospitals may lose.
For patients: Less stable and more expensive access to care
Millions of Americans are expected to lose medical coverage due to the measures in OBBBA, either because they no longer qualify for Medicaid or because they miss a reporting or renewal requirement. Healthcare costs will likely also go up, due to more expensive Marketplace coverage and new out-of-pocket fees for Medicaid services.
OBBBA could also increase coverage churn, with more Americans switching among Medicaid, Marketplace, and employer plans as their income, employment, and access to job-based insurance change. Those who stay on the same plan may still face changes in care, due to local providers reducing services.
All in all, OBBBA is expected to add barriers between patients and the care they need, whether in the form of interrupted treatment, unexpected bills, or loss of coverage altogether.
For providers: More unreimbursed care
Providers too are likely to see costs go up as they treat more uninsured or underinsured patients who cannot pay their full bills. Emergency physicians warn that coverage losses could push more patients into emergency departments, worsening crowding and wait times. Relatedly, the demand for financial assistance and charity care is expected to increase.
Even when care is reimbursable, providers may need to do more paperwork verifying eligibility and coverage or resolving denied or delayed claims. In states facing reduced federal Medicaid support, reimbursements may also decline if state programs reduce payment rates or funding.
The OBBBA’s effects on providers are ultimately felt by patients too. When hospitals cannot recover the cost of care, the consequences can be longer wait times for fewer services and facilities.
Preparing for greater pressure on patient access
Most of OBBBA’s largest Medicaid changes have yet to take effect, but early effects are already making headlines. Nearly 450,000 New Yorkers lost eligibility for their existing coverage on July 1, 2026, for example. The risks posed by OBBBA are particularly worrying for patients who need ongoing treatment, such as the 10% of adults with a history of cancer who are covered by Medicaid. Coverage disruptions could become a barrier to timely screening, diagnosis, and treatment.
At Cinnamon, we believe access support should be treated as part of patient care. Public funding may shrink, but patients’ need for treatment and guidance will not. Though we can’t close every gap public policy creates, we can, and must, work together to help make sure patients aren’t left to navigate those barriers alone.
