At A Glance
Providers must adopt OBBBA preparation strategies and new technologies to brace for the impact of increased self-pay patients, who account for the highest percentage of bad-debt write-offs, as well as additional administrative and documentation requirements, such as stricter eligibility checks and reporting mandates.
Key takeaways:
- The One Big Beautiful Bill Act (OBBBA) went into effect on July 4, 2025, but providers won’t see its full impact until 2027.
- Providers must prepare now for the influx of self-pay patients and increased administrative burden.
- Investing in AI and other technology can help providers identify patterns in patient data, predict coverage risks, and automate repetitive tasks.
The recent passage of the One Big Beautiful Bill Act is expected to bring sweeping reforms to America’s entire healthcare ecosystem, particularly major changes to Medicaid and Affordable Care Act (ACA) coverage. To avoid falling out of compliance and losing revenue, providers must be prepared to adapt swiftly. This article takes a closer look at what providers need to understand to prepare for OBBBA’s impact and streamline workflows, reduce administrative burdens, and protect revenue.
What the One Big Beautiful Bill Act means for healthcare providers
The OBBBA has a phased rollout, so providers won’t see the full impact until 2027. But providers must prepare now for the influx of self-pay patients, who account for the highest percentage of bad-debt write-offs, as well as additional administrative and documentation requirements, like stricter eligibility checks and reporting mandates. The first step for providers is to understand the impact. Then, providers must invest in the right technology—particularly AI-powered automation and front-end data solutions—to streamline workflows, reduce administrative burdens, and ensure a more efficient response to the new Medicaid landscape.
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1. Conduct a Medicaid exposure and gap analysis
Seventy-one million individuals are currently enrolled in Medicaid. Over the next decade, the Congressional Budget Office (CBO) estimates that 11.8 million individuals will lose health insurance coverage due to upcoming policy changes, such as more frequent eligibility checks and limits on eligibility for immigrants. With a gap analysis, providers can better understand their Medicaid exposure and how funding cuts will affect their patient and payer mix.
Key steps to performing a Medicaid exposure and gap analysis include:
| 1. Ask the right questions |
| Providers must first determine what types of information is needed to brace for OBBBA impact. It’s essential to look at: – Which patients are at risk of losing coverage? – Where are processes vulnerable or lacking? – What investments in advanced technologies can be made to streamline eligibility validation? |
| 2. Leverage artificial intelligence |
| Current gap analysis models may not be able to provide enough insight for OBBBA preparation. However, adopting AI-driven tools offers a better way to identify accurate patient demographics and financial data, automate eligibility checks, and improve insurance discovery at or before patient registration. |
| 3. Assess the ripple effect on 340B funding |
| Providers must also understand how a reduction in Medicaid enrollment will affect 340B funding. This federal program allows certain healthcare organizations to purchase reduced-cost outpatient drugs, and funding is directly tied to Medical enrollment levels. When Medicaid enrollment declines, it could affect hospitals’ drug purchasing capabilities and financial health. |
2. Prepare for a surge in self-pay patients and uncompensated care
Policy changes under OBBBA are expected to bring an influx of self-pay patients, increasing payment delays, write-offs and uncompensated care. Providers should take proactive measures to strengthen collection efforts to mitigate potential reimbursement delays.
Investing in AI-powered analytics helps providers gain the valuable insights needed to improve collections performance. Tools like Collections Optimization Manager from Experian Health offer powerful segmentation and automation based on data-driven, patient-centric insights.
When providers understand a patient’s ability and willingness to pay, billing teams can prioritize patient accounts most likely to pay. Tools that surface charity eligibility and payment options also drive more self-pay revenue. Refined patient education strategies will be important as patients struggle to understand their new financial responsibilities and coverage changes.
The financial impact of coverage loss
As OBBBA’s new policy changes roll out, preparedness for financial strain is imperative. Self-pay patients are often unable or unwilling to pay their balances in full. Nearly one in five adults carrying medical debt say they will never be able to pay it off, according to KFF data.
By 2034, uncompensated care costs are projected to increase by upward of $84 billion, according to another analysis. Additional data also suggests that OBBBA’s policy changes will impact healthcare organizations’ operating margins—and soon. By 2028, margins could drop as much as 17% for systems with a median net operating revenue of $1B to $2B.
3. Address administrative burdens with AI
The administrative burden of OBBBA’s policy changes could be just as disruptive to providers as the financial impact—especially when it comes to new compliance requirements. To prepare, revenue cycle leaders must immediately find ways to prioritize and optimize operational efficiency.
Additional employment verification requirements are expected to add to the heavy load of paperwork providers already manage for Medicaid. As new eligibility reviews, employment verification rules, and immigration status checks go into effect with OBBBA, streamlining fragmented and error-prone eligibility and discovery processes will be critical.
AI-enhanced solutions, like Experian Health’s Patient Access Curator™ (PAC), reduce billing errors and denials by flagging incomplete or inconsistent data before claims are submitted. automatically integrating the data back into EHR and billing systems. Optimizing front-end processes for patient registration and data collection reduces the administrative burden on already overextended staff while maximizing reimbursements.
As the healthcare industry prepares for the implementation of OBBBA, it’s clear that readiness is not one-size-fits-all.
Experian Health surveyed 200 healthcare decision-makers to get a better understanding of their readiness levels, where they’ll be impacted and what they’re focusing on, following implementation of the OBBBA.
The bottom line: Financial resilience depends on readiness
OBBBA will bring significant shifts to the healthcare industry—many of which could severely impact cash flow for providers that are not adequately prepared. According to a new Experian Health survey, only 14% of providers feel they are currently fully prepared for OBBBA changes, and about 40% report the need for major updates or overhauls.
However, providers who take early action and invest in scalable technology can minimize their revenue risks and compliance missteps.
Jason Considine, President at Experian Health, is optimistic about the importance of preparation and the long-term impact. He says:
“The journey forward is complex and will require some restructuring. If providers focus on breaking down silos and investing in predictive AI tools, comprehensive data, and adaptive workflows, there’s an opportunity for radical transformation through surviving the storm.”
Jason Considine, President at Experian Health
FAQs
The One Big Beautiful Bill Act (OBBBA), or H.R.1, is a United States budget reconciliation bill that was signed into law on July 4, 2024. It brings major shifts to Medicaid, Medicare and Affordable Care Act (ACA) marketplace plans.
OBBBA reforms are reshaping eligibility criteria, reimbursements and demand for charity care. These changes will affect how providers are reimbursed and could bring significant financial risk to healthcare organizations that are not adequately prepared.
Leaning into technology, like AI-powered platforms and tools, can help providers prepare for OBBBA’s financial and operational impact. Revenue cycle management software offers the capabilities and tools providers need to quickly respond to disruptions, mitigate revenue risk and streamline operations.
OBBBA went into effect on July 4, 2024, but the law has a phased rollout. However, providers are not expected to see the law’s full impact until 2027.
Find out how Experian Health’s revenue cycle management software can help your healthcare organization navigate upcoming regulatory shifts and changes.
