May 26, 2025
On May 22, 2025, the House of Representatives narrowly passed the "One Big Beautiful Bill Act" (H.R. 1), a comprehensive budget reconciliation measure that includes significant fiscal and policy changes. The bill, passed by a 215–214–1 vote, aims to extend tax cuts from the 2017 Tax Cuts and Jobs Act, increase defense and border security spending, and reduce federal spending by at least $1.5 trillion over the next decade. While the bill includes an important step forward in addressing Medicare physician payments by incorporating a partial inflationary update for 2026, many provisions remain concerning.
The bill could trigger automatic cuts to Medicare totaling approximately $500 billion due to the Pay-As-You-Go Act, potentially affecting services and provider reimbursements.
The bill proposes nearly $700 billion in cuts to Medicaid over the next decade. These reductions may include stricter eligibility requirements and work mandates for recipients aged 19–64. Medicaid is the primary payer for long-term care services and supports, including home and community-based services and nursing home care. The proposed cuts could strain these services, which are essential for many seniors and individuals with disabilities.
The bill now moves to the Senate, where it is expected to undergo revisions. PALTmed will continue to monitor and address concerns about the potential negative impacts on vulnerable populations and the implications of these proposed cuts.
