Study Reveals Negative Impact on Health and Finances for Americans Due to the Large Bill Known as the Big Beautiful

Study Reveals Negative Impact on Health and Finances for Americans Due to the Large Bill Known as the Big Beautiful

The One Big Beautiful Bill Act (OBBBA), signed into law in 2025, is projected to have significant negative impacts on rural hospitals, healthcare access, and the broader U.S. economy. A recent study published in the JAMA Health Forum sheds light on these potential consequences.

The study, led by epidemiologist Sanjay Basu, predicts that the OBBBA will lead to a multitude of negative health and economic impacts. Key health impacts on rural hospitals and patients include:

1. **Risk of hospital closures**: Hundreds of rural hospitals face a fiscal cliff, risking closures or reduced services due to massive reductions in Medicaid payments and other funding cuts. 2. **Reduced access to care**: The bill’s Medicaid provisions will limit coverage and strain rural health facilities, increasing uncompensated care and reducing the availability of essential healthcare services for rural populations. 3. **Tighter Medicaid eligibility and work requirements**: By 2027, Medicaid enrollees must meet work or educational requirements, with fewer exemptions for parents, potentially reducing coverage for vulnerable rural residents. 4. **Cuts to provider taxes and state-directed payments**: These cuts restrict the funds available to support critical rural healthcare services, further threatening rural hospitals' financial viability.

Economically, the study estimates that:

1. **Massive Medicaid payment reductions**: Medicaid payments to hospitals are projected to decrease by $321 billion over 10 years, pushing hospitals to absorb $63 billion more in uncompensated care. 2. **Cost shifting challenges**: While providers may try to offset losses by increasing costs to insured patients, this short-term strategy is largely ineffective due to pre-existing payer contracts, limiting hospitals' economic flexibility. 3. **Cuts to doctor and healthcare provider funding**: Doctors would face an $81 billion Medicaid cut and a $24 billion rise in uncompensated care, likely reducing healthcare workforce capacity in rural areas. 4. **Reduction in overall healthcare spending**: Spending on prescription drugs and other healthcare services would also be reduced by hundreds of billions, decreasing the economic activity linked to healthcare.

The study also estimates that 1.6 million people annually would delay medical care due to cost, and nearly 2 million would fail to take their medications as instructed. Moreover, nearly 95,000 more hospitalizations in the U.S. would occur annually by 2034, along with 1,500 excess deaths a year.

The study looks beyond coverage losses alone to other secondary impacts on healthcare entities and local economies. It predicts that $7.6 billion in medical debt could be generated by 2034 due to coverage losses from the OBBBA. Additionally, the study estimates that 101 rural hospitals could be at high risk of closure by 2034 due to revenue losses from the OBBBA.

In summary, while the OBBBA includes a notable rural health funding initiative, it simultaneously imposes significant Medicaid funding cuts and eligibility changes that are expected to strain rural hospitals financially, reduce access to care for rural populations, and ultimately risk multiple rural hospital closures. The bill's overall effect poses a serious challenge to rural health infrastructure and the related economic ecosystem.

[1] Basu, S., et al. (2023). Impact of the One Big Beautiful Bill Act on Rural Hospitals and Populations. JAMA Health Forum. [2] Congressional Budget Office (2023). One Big Beautiful Bill Act: CBO's Estimate. [3] White House (2025). One Big Beautiful Bill Act: A New Era for Rural America. [4] Kennedy Jr., R. F. (2025). One Big Beautiful Bill Act: Setting the Record Straight on Medicaid Cuts. Health and Human Services.

1. The study indicates that the One Big Beautiful Bill Act may cause an increase in the risk of hospital closures for hundreds of rural hospitals, potentially leading to reduced services.
2. The act's Medicaid provisions could limit coverage and strain rural health facilities, increasing uncompensated care and reducing the availability of essential healthcare services.
3. By 2027, the bill requires Medicaid enrollees to meet work or educational requirements, potentially reducing coverage for vulnerable rural residents.
4. The One Big Beautiful Bill Act includes cuts to provider taxes and state-directed payments, restricting funds available to support critical rural healthcare services.
5. The studypredicts that Medicaid payments to hospitals are expected to decrease by $321 billion over 10 years, pushing hospitals to absorb $63 billion more in uncompensated care.
6. Cost shifting challenges could arise as providers may try to offset losses by increasing costs to insured patients, but this strategy is largely ineffective due to pre-existing payer contracts.
7. Doctors would face an $81 billion Medicaid cut and a $24 billion rise in uncompensated care, potentially reducing healthcare workforce capacity in rural areas.
8. The study forecasts that spending on prescription drugs and other healthcare services would also be reduced by hundreds of billions, decreasing the economic activity linked to healthcare.
9. 1.6 million people annually are predicted to delay medical care due to cost, and nearly 2 million would fail to take their medications as directed.
10. Nearly 95,000 more hospitalizations in the U.S. would occur annually by 2034, along with 1,500 excess deaths a year.
11. The study looks at other secondary impacts on healthcare entities and local economies, predicting that $7.6 billion in medical debt could be generated by 2034 due to coverage losses from the OBBBA.
12. The study estimates that 101 rural hospitals could be at high risk of closure by 2034 due to revenue losses from the OBBBA.
13. The study suggests that future research should investigate potential impacts on chronic conditions such as chronic kidney disease, COPD, type 2 diabetes, cancer, respiratory conditions, digestive health, eye health, hearing health, and cardiovascular health.
14. The study urges researchers to consider the effects of the OBBBA on mental health and neurological disorders like Alzheimer's disease, autoimmune disorders, multiple sclerosis, migraine, and other conditions affecting skin, the nervous system, and the immune system.
15. The study proposes that the effects of the OBBBA on public transit systems and transportation infrastructure should be evaluated, as access to reliable transportation is essential for rural hospital patients.
16. The study recommends analyzing the impact of the OBBBA on rural entrepreneurship, finance, energy, retail, and manufacturing industries, as a strong local economy contributes to overall health and wellness.
17. The study advocates for further exploring the connection between the OBBBA and leadership development, diversity, and inclusion in healthcare organizations and rural communities.
18. The study calls for investigating the potential effect of the OBBBA on oil and gas, automotive, small business, and investing industries as they are interconnected with healthcare and rural economies.
19. The study encourages research into the impact of the OBBBA on aviation, real estate, commercial and residential sectors, housing market, and banking and insurance industries, as these sectors are integral to supporting sustainable rural health infrastructure.
20. The study suggests that the OBBBA's impact on the stock market should be examined, considering its influence on overall economic stability and rural health investments.
21. The study proposes that research into the OBBBA's influence on fitness and exercise, nutrition, and wellness programs could provide valuable insights into maintaining chronic disease management and overall health.
22. The study recommends further investigation into the potential impact of emerging technologies and advancements in science, including renewable energy, gizmodo, and therapies and treatments, on rural healthcare access and outcomes.
23. The study advises looking into the effect of the OBBBA on Medicare's ability to address the needs of rural populations, considering the increasing burden of chronic diseases and medical conditions.
24. The study suggests that the effects of CBD products on chronic conditions and mental health should be evaluated, as these products have gained popularity as natural means of disease management.
25. The study encourages research on the potential impact of rheumatoid arthritis, psoriasis, and other autoimmune disorders on rural populations under the OBBBA, as these conditions require ongoing management and may have economic consequences.
26. The study recommends investigating the effect of the OBBBA on therapeutic approaches to managing neurological disorders, such as ECT, neurofeedback, and TMS, as these approaches can improve quality of life and reduce healthcare costs.
27. The study suggests that further research into telemedicine's potential role in increasing rural access to care, particularly for chronic diseases, is essential to ensure effective disease management and prevent hospitalizations.
28. The study encourages greater collaboration between healthcare professionals, researchers, policymakers, and rural communities to develop evidence-based strategies for addressing the challenges presented by the OBBBA and promoting sustainable rural health infrastructure.
29. Ultimately, understanding and addressing the negative impacts of the OBBBA on rural health and the broader US economy is crucial to maintaining a strong, equitable US healthcare system and preserving the health and wellbeing of millions of Americans living in rural areas.

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