17 Jun What the “One Big Beautiful Bill” Means for Health Care

July 17, 2025 ~ At Triage Cancer, we believe it's important to stay informed about potential changes to the law that could impact access to care. One such policy is the proposed budget reconciliation bill, also referred to as the “One Big Beautiful Bill.”

This sweeping legislation contains several provisions that could impact the cancer community. It includes changes to Medicaid, Medicare, the Affordable Care Act's (ACA) State Health Insurance Marketplaces, and Health Savings Accounts (HSAs).

What Is a Budget Reconciliation Bill?

A budget reconciliation bill is a special type of legislation focused solely on changes to federal spending and revenue. It differs from regular legislation in two important ways:

• Content restrictions: Only provisions that affect federal spending or revenue can be included.
• Passage process: It only requires a simple majority (51 votes) in the Senate, bypassing the usual 60-vote threshold.

This process gives the majority party in Congress more power to advance budget and policy changes, including those related to health care.

How the Bill Would Affect the ACA's Health Insurance Marketplace

Shortened Open Enrollment

In previous years, open enrollment for ACA Health Insurance Marketplace plans lasted from November 1 to January 15. Under the reconciliation bill, that window would be shortened to November 1 through December 15, starting in 2025. A shorter enrollment period may make it harder for individuals and families to secure timely health insurance coverage.

Elimination of Year-Round Enrollment for Individuals with Low-Incomes

Currently, individuals earning below 150% of the Federal Poverty Level (FPL) in states using the federally run Marketplace are eligible for a special year-round enrollment period. The bill would eliminate this special enrollment starting in 2026. This limits enrollment to the annual open period.

Changes to Eligibility for Immigrants

Today, many lawfully present immigrants—including refugees, asylees, and Temporary Protected Status (TPS) holders—can enroll in Marketplace coverage and receive subsidies. The bill would restrict eligibility beginning January 1, 2027, excluding many of these groups. Additionally, Deferred Action for Childhood Arrivals (DACA) recipients would become ineligible as of January 1, 2026.

Stricter Verification Requirements

Currently, people buying a Marketplace plan just have to attest that their personal information is correct to receive conditional financial assistance. Government agencies confirm their information using various databases. If the information does not match, they can keep their insurance and financial assistance for up to 90 days while they submit additional documentation. Starting in 2026, individuals whose information is not already available through the U.S. Treasury would be required to submit documentation before receiving coverage, potentially delaying or preventing access.

How the Bill Would Affect Medicaid

More Frequent Eligibility Reviews

Currently, states must review someone’s Medicaid eligibility once every 12 months. The bill would require that states conduct eligibility redeterminations every 6 months for individuals with incomes above 100% of the FPL. This requirement would begin with renewals scheduled on or after December 31, 2026.

Mandatory Cost Sharing

States currently have the option to impose out-of-pocket costs on higher-income Medicaid enrollees. However, federal law does not require states to do so. States would need to charge up to $35 per service under the bill for individuals above 100% FPL, effective October 1, 2028. However, certain services—such as emergency care, pregnancy-related care, family planning, and preventive services—would be exempt. The existing 5% cap on total out-of-pocket spending as a percentage of family income would remain in place.

Nationwide Work Requirements

Currently, states need special waivers to require Medicaid recipients to work. Only Georgia has such a waiver in effect. The bill would require all states to impose mandatory work requirements or qualifying activity requirements (80 hours/month) for non-exempt adults ages 19–64 no later than December 31, 2026. Waivers would no longer be allowed.

⚠️ Impact: The Congressional Budget Office estimates that the Medicaid provisions would cause 7.8 million people to lose coverage by 2034.

How the Bill Would Affect Medicare

Delayed Access to Medicare Savings Programs

The Centers for Medicare & Medicaid Services (CMS) finalized rules in 2023 to streamline access to Medicare Savings Programs (MSPs), which help low-income beneficiaries with out-of-pocket Medicare costs. These rules were scheduled to take effect at the end of 2024. The reconciliation bill would delay implementation until January 1, 2035.

New Restrictions on Legal Immigrant Eligibility

Currently, legal residents aged 65 and older who meet work and residency requirements are eligible for premium-free Medicare Part A. Others who have resided in the U.S. continuously for 5 years can purchase coverage. The bill would exclude certain legal residents, including refugees, asylees, and TPS holders—even if they meet all other eligibility criteria. Existing beneficiaries in these groups could have their Medicare benefits terminated within one year of enactment.

How the Bill Would Affect Health Savings Accounts (HSAs)

Expanded HSA Usage

Under current law, Health Savings Account (HSA) funds may only be used for qualified medical expenses. Starting January 1, 2026, the bill would allow HSA funds to be used for some fitness-related costs, such as gym memberships.

Increased Contribution Limits

The bill would double the annual contribution limits for HSAs. However, higher earners would see those increases phased out for individual incomes between $75,000–$100,000 and household incomes between $150,000–$200,000. These changes would also take effect January 1, 2026.

What You Can Do

These proposed changes could significantly affect access to health care, particularly for people impacted by cancer, chronic illness, or economic hardship. If you are concerned about the bill:

• Contact your U.S. Senators before July 4, when the Senate is expected to vote. The Senate released their version of this bill on Monday, June 16. We are still reviewing this version.
• If the Senate passes the bill with amendments, it will return to the House of Representatives for approval—so you can also contact your Representative to share your views.

Stay Informed. Stay Involved.

Major health policy changes—like those in the “One Big Beautiful Bill”— could have far-reaching impact on the cancer community. If you are interested in learning more about engaging in advocacy, please visit our Advocacy Resource Hub.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through events, materials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

We're glad you find this resource helpful! Please feel free to share it with your communities or to post a link on your organization's website. However, this content may not be reproduced, in whole or in part, without the express permission of Triage Cancer. Please email us at info@TriageCancer.org to request permission. © 2025 Triage Cancer