The One Big Beautiful Bill Act of 2025 (OBBBA), the massive budget reconciliation bill implementing many of the administration’s top legislative priorities, was signed into law (Public Law 119-21) on July 4, 2025. The law includes significant funding cuts and policy changes to Medicaid and the Health Insurance Marketplaces, Medicare physician payment and medical student loans, among other health care related items, all of which will worsen patient access to care.
Some of the key provisions include:
- Medicaid. OBBBA creates new administrative requirements and conditions on eligibility (including work requirements) for patients seeking to enroll in or maintain Medicaid coverage and restricts states’ ability to use provider taxes to finance their Medicaid programs.
- Access to health insurance coverage through the Affordable Care Act (ACA) marketplaces. OBBBA imposes verification requirements for patients receiving premium tax credits, including pre-enrollment verification requirements that will effectively end automatic re-enrollment for these patients. OBBBA does not address the scheduled expiration of enhanced tax credits at the end of 2025.
- Federal support of medical student loans. OBBBA, in part, removes the ability for medical students to receive Federal Direct Stafford loans and Federal Direct PLUS Loans (medical students will still be able to access Federal Direct Unsubsidized Stafford loans), caps the amount that can be borrowed for school, and limits new federal student loan borrowers to only two repayment options.
- Medicare physician payment reform. OBBBA includes a temporary one-year 2.5% conversion factor update for 2026, replacing the original House bill that called for a 75% MEI inflation update in 2026 followed by an annual 10% MEI increase, leaving no permanent, inflation-adjusted payment fix.
More detailed information on the different provisions in OBBBA is provided in the following sections.
AMA resources
- Summary of select provisions and implementation dates of OBBBA (PDF)
- Implementation timeline for ACA, Medicaid, Medicare, SNAP, and Student Loan Provisions of OBBBA and the Marketplace Integrity and Affordability Final Rule (PDF)
- Summary: Changes to Medicaid and CHIP enrollment, eligibility and cost-sharing (PDF)
- Summary: Changes to Medicaid financing (PDF)
- Summary: Medicaid community engagement requirements (PDF)
- Summary: Rural Health Transformation Program (PDF)
- Summary: Changes to ACA marketplace eligibility, enrollment and affordability (PDF)
- Summary: Changes to ACA marketplace eligibility and access for immigrants (PDF)
- Issue brief: Extension of enhanced premium tax credits key to ACA marketplace affordability (PDF)
- Federal student loans and the One Big Beautiful Bill Act (PDF)
Press statements
- May 22, 2025: The AMA issued a statement in response to the passage of the House reconciliation bill, advocating against provisions which would have significant and negative impact on the ability of eligible individuals to access and maintain Medicaid/ACA coverage, as well as restrict access to medical school loans and loan forgiveness.
- June 20, 2025: The AMA issued a statement urging the Senate to avoid making changes that reduce access to care in their work on the reconciliation bill.
- July 1, 2025: The AMA issued a statement against the proposed cuts to federal health care programs, including Medicaid and CHIP, in the Senate-passed reconciliation bill.
- July 3, 2025: The AMA issued a statement expressing outrage at the passage of OBBBA, which will cause an estimated 11.8 million people to lose health care coverage.
Advocacy
- Sept. 15, 2025: The AMA, along with 90+ physician organizations, sent a letter (PDF) to congressional leadership urging extension of enhanced advanced premium tax credits.
- May 20, 2025: The AMA sent a letter (PDF) to House leadership offering comments on provisions within the legislative proposal pertaining to Medicare physician payment, Pharmacy Benefit Manager (PBM) transparency, Medicaid and the Children’s Health Insurance Program (CHIP), artificial intelligence (AI), the Affordable Care Act (ACA) marketplaces, and federal support of medical student loans.
- June 9, 2025: The AMA signed on to a letter (PDF) to Senate leadership urging restoration the pass-through entity taxes (PTET) deduction, which was eliminated in the House-passed version of the reconciliation bill.
- June 20, 2025: The AMA sent a letter (PDF) to Senate leadership commenting on various provisions being considered in the reconciliation bill, including those related to Medicaid and CHIP, access to health insurance coverage through ACA marketplaces, federal support of medical student loans, artificial intelligence and Medicare physician payment reform.
