Healthcare Provisions Within the “Big Beautiful Bill”: Exacerbating Failed Policies

The comprehensive legislation, dubbed by some the “Big Beautiful Bill” (BBB), includes a substantial set of provisions pertaining to healthcare. These proposals aim to reform Medicaid, Medicare, the Affordable Care Act (ACA), and other health-related sectors. However, rather than offering genuine solutions, these healthcare sections largely entrench and expand failed federal programs. Market-based and state-level solutions are the appropriate path forward; continuing with the current trajectory will only worsen our $37 trillion national debt and further degrade our healthcare system.

Medicaid and CHIP: Entrenching a Failed System

A significant portion of the bill addresses Medicaid and the Children’s Health Insurance Program (CHIP), programs that have demonstrably failed to deliver efficient, fiscally responsible healthcare.

• Enrollment and Eligibility: Provisions imposing moratoriums on recent rules for Medicaid/CHIP enrollment (Sec. 44101, 44102), while citing concerns over states’ ability to remove ineligible enrollees, tinker at the edges of a fundamentally broken system. Robust income verification, streamlined through tax data, is essential, but this addresses symptoms, not the core disease of these programs. The argument that the delayed rules could weaken verification standards only underscores the inherent vulnerability to fraud and improper payments within these federal structures.
• The mandate for states to improve enrollee address information and participate in a federal system to prevent multi-state enrollment by 2029 (Sec. 44103) is a minor, albeit logical, measure within a system that requires wholesale replacement.
• Quarterly screenings against the Death Master File (Sec. 44104) and enhanced provider screening (Sec. 44105, 44106) are basic anti-fraud measures that should have been rigorously implemented decades ago, and their inclusion now highlights past failures.
• Increasing eligibility redeterminations to every six months (Sec. 44108) will inevitably create more bureaucracy, not genuine integrity, within these failed expansion programs. Stringent initial enrollment criteria are necessary, but the programs themselves are the problem.
• Proposed revisions to home equity limits for Medicaid long-term care (Sec. 44109) are an egregious component of a system that forces asset depletion. The link between Medicaid and long-term care services must be severed entirely.
• Prohibiting Federal Financial Participation (FFP) for individuals without verified immigration status (Sec. 44110) is a necessary, though insufficient, step toward fiscal discipline.
• Conversely, efforts to “streamline” enrollment for out-of-state providers (Sec. 44302) are a pathway to inefficient contracting and cronyism, typical of bloated federal programs.

• Spending and Program Integrity:
• The removal of the good faith waiver for certain erroneous excess Medicaid payments (Sec. 44107) is an admission of the rampant improper payments that plague the system, reinforcing the argument that Medicaid must be abolished.
• Modifying retroactive Medicaid/CHIP coverage (Sec. 44122) is a trivial adjustment.
• Federal intervention in pharmacy payments (Sec. 44123, 44124) is an unacceptable overreach. Free markets, not government dictates, ensure fair pharmacy pricing.
• The prohibition of federal Medicaid/CHIP funding for gender transition procedures (Sec. 44125, Sec. 112030) is correct; such funding has no place at the federal level and should be entirely a private matter, with no exceptions for federal dollars.
• Prohibiting federal payments to “prohibited entities” in family planning (Sec. 44126) is a sound policy; such funding decisions should be eliminated from public coffers altogether.
• Sunsetting increased FMAP for new Medicaid expansion states (Sec. 44131) and imposing a moratorium on new provider taxes (Sec. 44132) are welcome, as no new taxes should support these failing programs.
• Revising payments for state-directed Medicaid based on Medicare rates (Sec. 44133) perpetuates federal price-fixing. Medicaid must be dismantled, replaced by a system focused on transparently priced emergency and preventative services, potentially leveraging innovations like robotic-assisted procedures to reduce costs and liability.
• Mandating Medicaid community engagement requirements (Sec. 44141) is a gross federal intrusion into matters that are exclusively state or local concerns.
• Modifying cost-sharing for Medicaid expansion individuals (Sec. 44142) is merely propping up a failed expansion of a failed program using flawed metrics like the federal poverty line. The entire edifice needs to be replaced with free-market solutions.

Affordable Care Act (ACA): A Failed Experiment Requiring Full Repeal

The ACA has failed to make healthcare affordable or accessible in any meaningful way. The bill’s proposed changes to this Act are cosmetic and avoid the necessary solution: full repeal.

• Measures to address waste and fraud in ACA Exchanges (Sec. 44201) are an admission of the system’s inherent flaws. The ACA Exchanges must be abolished, not tweaked.
• Pre-enrollment income verification for subsidies (Sec. 44201) if tax data is unavailable, and mandating tax reconciliation for APTCs (Sec. 44201), are attempts to manage a system of tax credits that should not exist.
• Appropriating funds for cost-sharing reduction (CSR) payments (Sec. 44202) continues to pour taxpayer money into a failed model.
• Revising rules on actuarial value and re-enrollment (Sec. 44201) fails to recognize that the metallic tiers (bronze, silver, etc.) are bureaucratic nonsense.
• Limiting premium tax credit eligibility to “eligible aliens” (Sec. 112101), with arbitrary inclusions, is ridiculous.
• Provisions regarding premium tax credits during Medicaid ineligibility (Sec. 112102) and eliminating limits on recapturing excess advance payments (Sec. 112203) add layers to a convoluted system that must be entirely dismantled.

Medicare: Perpetuating Federal Inefficiency

Medicare, another pillar of federal healthcare overreach, is also failing. Proposed modifications within this bill do little to alter its unsustainable trajectory.

• Adjusting the Medicare physician fee schedule (Sec. 44304) continues federal price-setting, which distorts the market.
• Expanding the definition of “rural emergency hospital” (Sec. 111201) is more federal micromanagement.
• Limiting Medicare coverage to specific categories (Sec. 112103) is a half-measure; eligibility should be strictly limited to U.S. citizens to curb bureaucratic expansion.
• Mandating AI tools to recoup improper Medicare payments by 2027 (Sec. 112204) is a federal technology mandate; such decisions belong at the state or local level.
• Provisions for PBM accountability in Medicare Part D (Sec. 44305), while claiming transparency, will entrench regulated fee structures. Pharmacy benefits must be divorced from Medicare, allowing free-market competition and true price transparency.
• Expanding the orphan drug exclusion (Sec. 44301) is a minor, acceptable adjustment in an otherwise flawed program.

Health Savings Accounts (HSAs) and Other Tax Provisions: Misguided Policies

The bill’s expansion of HSAs further entrenches a flawed approach to healthcare funding. HSAs are not a solution.

• All provisions expanding HSA eligibility or utility (Sec. 110204 – Sec. 110213) promote a mechanism that has failed to control costs or provide meaningful benefits for most Americans. HSAs disproportionately benefit the wealthy, require high-deductible plans that shift costs to individuals, and do little to address the root causes of high healthcare expenses. HSAs and FSAs should be discontinued, with a focus on drastically reducing the underlying costs of healthcare services.

Other Health-Related Provisions: Continued Federal Overreach

• Changes to SNAP’s Thrifty Food Plan (Sec. 10001) and repealing funding for nutrition programs (Sec. 10011) are noted; federal intervention in nutrition is often ineffective and wasteful.
• Federal employee health benefits (Sec. 90004) must be scrutinized to prevent undue taxpayer burden. Rigorous oversight of SNAP to combat fraud is also essential.

In conclusion, the healthcare provisions within the BBB largely represent a doubling-down on failed federal policies that have driven up costs, expanded bureaucracy, and contributed significantly to our national debt. Medicaid, Medicare, and the ACA are not programs to be tweaked; they are failed systems requiring decisive replacement with state-led, market-based solutions. Only a fundamental shift away from federal control can restore fiscal sanity and create a healthcare system that truly serves the American people.