New state-by-state analysis finds reconciliation bill would cut healthcare spending
Greetings—
We wanted to follow up on our previous email to share Urban’s latest analysis on the implications of the House-passed reconciliation bill—the One Big Beautiful Bill Act—on health care spending and uncompensated care. Using updated Congressional Budget Office projections and a refined approach, the analysis finds that if passed by the Senate, the bill could lead to a reduction of $797 billion in health care spending over the next decade, with hospitals and physicians facing an overall decline of $321 billion and $81 billion, respectively.
More than one-third of the decline in spending from the reconciliation bill would occur in California, Texas, New York, and Florida. Spending declines would be more than $20 billion in nine additional states: Arizona, Georgia, Illinois, Indiana, North Carolina, Ohio, Oregon, Pennsylvania, and Washington.
If Congress also allows the expiration of enhanced tax credits, there would be an additional $262 billion decline in health care spending from 2025–2034, with the largest spending declines in the eight states that have not expanded Medicaid: Texas, Florida, Georgia, Tennessee, South Carolina, Louisiana, Alabama, and Mississippi.
The bill’s provisions would cause a $204 billion increase in demand for uncompensated care sought by those without insurance between 2025 and 2034, with the largest increases in demand concentrated in California, Texas, New York, and Florida. The expiration of the enhanced tax credits would cause an additional increase of $79 billion in demand for uncompensated care over the same 10-year period.
If you have questions for the research team, please reply to this email and we can connect you.
Greetings—
Health care providers could lose $771 billion in revenue over the next decade due to combined losses of Medicaid and Marketplace coverage in the reconciliation bill passed by the House of Representatives, Urban Institute researchers find in a new analysis. These coverage losses would also lead to an increase in uncompensated care sought by the uninsured of almost $200 billion over this same period.
At the same time, enhanced premium tax credits (PTCs) are due to expire at the end of 2025, which researchers estimate would lead to an additional loss of $261 billion for providers and an increase in uncompensated care demand of $78 billion.
A decrease in spending on health care services of $1.03 trillion between 2025 and 2034 – three-quarters ($771 billion) from the reconciliation bill’s provisions. Forty percent of the total decline would be attributable to hospitals ($408 billion), 11 percent to physician services ($118 billion), 26 percent to other services ($272 billion), and 23 percent to prescription drugs ($234 billion).
A spike in uncompensated care sought by the uninsured by $278 billion over the same timeframe, most from the reconciliation bill’s provisions ($198 billion). $83 billion of the overall increase in uncompensated care would be attributable to hospital services, $34 billion for physician services, $107 billion for other services, and $54 billion for prescription drugs.
Read the report
to learn more. Forthcoming work from the researchers will include state-by-state estimates on the health care spending changes associated with the reconciliation bill and expiration of enhanced subsidies.
If you have questions for the research team, please reply to this email. We’re happy to connect you.
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