Ambulance agencies should continue to work with national and state advocacy associations to monitor the developments related to the One Big Beautiful Bill Act of 2025, as well as CMS’s May 12, 2025 Preserving Medicaid Funding for Vulnerable Populations - Closing a Health Care-Related Tax Loophole Proposed Rule, and the status of the ongoing CMS OIG audits of Medicaid ambulance supplemental payment programs (GEMT).
These developments could have a significant impact on things like payer mixes, supplemental payment programs, and potential Medicare payment reductions through the Statutory Pay‑As‑You‑Go Act of 2010 (S-PAYGO) sequestration provisions.
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GOP tax bill will cost health sector $1T: CBO
Michael McAuliff
June 04, 2025
https://www.modernhealthcare.com/politics-policy/tax-bill-medicaid-cuts-cbo-gop
The Republican tax-and-spending-cuts legislation speeding through Congress would take more than $1 trillion out of the healthcare system over a decade, according to an analysis the Congressional Budget Office published Wednesday.
The nonpartisan agency's fullest accounting of the House-passed One Big Beautiful Bill Act of 2025 details how President Donald Trump and the GOP-led Congress intend to slash federal spending to partially offset trillions of dollars in tax cuts. In healthcare, Medicaid would be subject to the lion's share of the cuts and see its federal budget diminish by $864 billion. The work requirement provisions alone would reduce spending by $344 billion.
The CBO projects that the Medicaid cuts and other policies would lead to 10.9 million people becoming uninsured, including 7.8 million who would lose Medicaid benefits.
The estimated Medicaid cuts and the increase in the uninsured are higher than under previous CBO reports because the House made last-minute changes to the measure before sending it to the Senate last month, such as moving the start date for Medicaid work requirements from 2029 to 2026.
Most of the healthcare cuts come from the section of the bill authored in the House Energy and Commerce Committee, which total $1 trillion. The House Ways and Means Committee's part of the bill includes several policies targeted at the Affordable Care Act of 2010 that would crimp premium tax credits for migrants and step up eligibility checks for everyone to save about $230 billion. Those provisions account for about 2.3 million people losing insurance.
Democrats were quick to blast the bill based on the new score.
“We’ve said from the beginning that the numbers would only get worse," Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) said in a news release.
“It’s shocking House Republicans rushed to vote on this bill without an accounting from CBO on the millions of people who will lose their healthcare or the trillions of dollars it would add to the national debt," Pallone said. "The truth is Republican leaders raced to pass this bill under cover of night because they didn’t want the American people or even their own members to know about its catastrophic consequences.”
Another 4.2 million people would become uninsured if Congress and Trump don't extend the enhanced health insurance exchange subsidies due to expire at the end of the year, according to a separate analysis the CBO presented to Pallone, Ways and Means Committee ranking member Richard Neal (D-Mass.) and Senate Finance Committee ranking member Ron Wyden (D-Ore.) on Wednesday.
An additional 900,000 would lose exchange coverage as a result of a proposed rule the Centers for Medicare and Medicaid Services issued in March, which would shorten the annual enrollment period, require stricter eligibility reviews and make other changes to the marketplaces, the CBO reported to the Democratic lawmakers.
The combined effects of those policies and the One Big Beautiful Bill Act would result in 16 million more uninsured people by 2024, the CBO concluded.
The Senate is working on the tax bill now, with GOP senators holding meetings on how they would like to modify the bill. While nearly every Republican has embraced cutting waste, fraud and abuse in healthcare, some have raised concerns about how deep the Medicaid cuts will be, and have signaled they will listen to constituents to determine if they go too far.
Republican Sens. Susan Collins (Maine), Lisa Murkowski (Alaska) and Josh Hawley (Mo.) have been the most vocally resistant to the steep Medicaid cuts.
On Tuesday, Hawley expressed unease in particular about proposed limits on the provider taxes states levy to help finance their share of Medicaid spending, which he described as essential for rural hospitals. Hawley also said he disliked the provisions that would impose cost-sharing requirements on some Medicaid enrollees, dubbing it a "sick tax."
"I don't want to see Medicaid benefit cuts in the state, and I don't want to see rural hospitals close," Hawley said.
Yet Republicans including Sens. Mike Lee (Utah), Dr. Rand Paul (Ky.) and Ron Johnson (Wis.) are pushing for bigger cuts.
Senate Majority John Thune (R-S.D.) said Republicans are working through the issues, and may identify other possible cuts while satisfying the senators who want to soften the Medicaid provisions.
"We have an agenda that everybody campaigned on, most notably the president of the United States, and we're going to deliver on that agenda. And the legislation that was passed by the House will be approved here, strengthened in the Senate," Thune said Tuesday. "When it's all said and done, we'll send it back to the House and hope that they can pass it and put it on the president's desk."
