House Passes Reconciliation Bill
Early this morning the House passed the reconciliation bill (One Big Beautiful Bill Act of 2025) that includes provisions that affect nearly every sector of the health care industry.
Overall Summary
The best summary I’ve seen is in modern healthcare here ($). Overall, the bill cuts more than $1 trillion dollars in federal healthcare spending over the next 10 years
- Medicaid – The largest cuts affect Medicaid. It establishes mandatory work requirements for adult enrollees who don’t have conditions no later than December 31, 2026. This is a very aggressive timeline. It also bans new provider taxes and limits state directed payments. There’s a number of other provisions that limit eligibility
- ACA – Increases verification standards, ban auto-enrollment, limits legal immigrants, expands ICHRAs, and includes CSR payments to issuers that do not cover abortions.
- Medicare – Increases Medicare physician reimbursement 2% in 2026 and indexes payment updates to the Medicare economic index. Suspends rule on facilitated enrollment for MSP. It would trigger the PAYGO sequestration (4%)
- PBMs – Bans spread pricing
- Providers – Would increase uncompensated care. We don’t have a CBO score, but the number of uninsured people should increase over the next 3-4 years by 15+ million.
Timeline/Next Steps
The Bill will go to the Senate – who will pick it up on June 2nd. The expectation is that the bill will change in some form. The goal is passage before the July 4th recess although it could slip later into July and even August
CMS Announcement on RADV for MA
CMS announced that it would commit significant resources and a plan to complete all remaining MA RADV audits for PY 2018 to PY 2024 by early 2026. CMS intends to audit all eligible MA plans each year in all newly initiated audits. You can read the entire press release here.
