Welcome to another round of PYA Washington Updates! It’s been a busy week. Here are the latest developments on the healthcare front:
OBBBA: CBO Score
On Wednesday, the non-partisan Congressional Budget Office (CBO) released its final analysis of H.R. 1, The One Big Beautiful Bill Act’s (OBBBA) impact on federal spending. According to the CBO, OBBBA will reduce federal revenue by $3.7 trillion and cut spending by $1.2 trillion over the next ten years, thus increasing the federal deficit by $2.4 trillion. The cuts include reductions in federal spending on ACA Marketplace coverage by $301 billion and Medicaid by $806 billion.
The CBO’s analysis shows that the Medicaid cuts would increase by 7.8 million the number of people without health insurance in 2034 (including 1.4 million undocumented immigrants who would no longer be covered under state-funded plans). The cuts to federal spending on ACA Marketplace coverage would increase the number of uninsured individuals by 3.6 million (1.3 million from cuts made by the House Energy & Commerce Committee and 2.3 million from tax changes made by the Ways and Means Committee).
The CBO notes that it has not yet “completed an analysis of the macroeconomic effects of [OBBBA] or [its] additional budgetary effects,” meaning it has not evaluated the bill’s overall impact on the economy (e.g., impact on unemployment rate, inflation). The White House claims OBBBA’s positive effects on the economy will wipe out any deficit impact.
OBBBA: Other Analyses of Note
This week, doctors’ associations and medical schools warned that provisions in the House-passed bill to restrict graduate federal student loans could worsen the national shortage of doctors. One study found these restrictions could impact more than 60% of students pursuing medicine and other health professions. Also, concerns regarding the impact of the Trump Administration’s immigration policies on the healthcare workforce are growing. With about a million non-citizen immigrants working in healthcare (of which about 65% are legal immigrants), large-scale deportations would leave numerous positions unfilled. And on Thursday, America’s Essential Hospitals, the trade association for safety net hospitals, released its report projecting that OBBBA would increase hospital uncompensated care costs by at least $42.4 billion in 2034.
OBBBA: The Senate’s Version
The Senate now is working on drafting its version of OBBBA, mostly behind closed doors. Yesterday, news reports circulated that some Senators want to cut payments to Medicare Advantage plans, claiming the plan would generate $250 billion in savings. And there’s noise that other Medicare cuts may be on the table, although details are sparse. The push is on to have some version of OBBBA on President Trump’s desk before our nation’s 249th birthday.
HHS Budget In Brief
Last Friday afternoon, the White House released the US Department of Health and Human Services (HHS) Budget in Brief(BIB), detailing the Trump Administration’s discretionary funding request for the agencies and divisions under HHS. (As discussed previously, spending on Social Security, Medicare, and Medicaid is mandatory spending and not subject to the annual appropriations process.) Most of those agencies and divisions also released their congressional justifications (CJs) detailing their spending plans. The BIB is consistent with the top line numbers in the “skinny” budget released in early May – including an overall 26.2% reduction in HHS appropriations. However, the BIB provides significantly more detail regarding the HHS reorganization (what department functions are going where) and funding for individual agencies and divisions. The biggest loser is the National Institutes of Health, which stands to have its current budget cut by 40%.
Rescinded EMTALA Guidance
Shortly after the Dobbs decision was handed down, the Biden Administration advised hospitals that they were obligated under EMTALA to provide emergency abortions if the mother’s health is at risk, noting that the federal law trumped any contrary state law provision. The guidance targeted those states whose laws prohibit abortions except in cases in which the mother’s life is at risk. This week, the Trump Administration rescinded the guidance, claiming it is “work[ing] to rectify any perceived legal confusion and instability created by the former administration’s actions.” According to the press release, “CMS will continue to enforce EMTALA, which protects all individuals who present to a hospital emergency department seeking examination or treatment, including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy. but did not go so far as to say state law trumps hospitals’ EMTALA obligations.”