Healthcare coverage of the One Big Beautiful Bill Act (OBBBA), including ours, has rightfully focused on the massive cuts to federal healthcare spending, with the final Congressional Budget Office score coming in at $1.1T over ten years. As detailed by KFF analysis, 37 states will see over 13 percent of their 10-year federal Medicaid outlays cut, and Medicaid expansion states that have larger rural populations will bear the worst brunt. However, there are other direct and indirect healthcare policy changes that have significant care delivery implications. Two pieces of relief for providers relate to an expansion of reimbursement permissions for employer-based plans with health savings accounts (HSAs). As introduced during COVID but briefly allowed to expire, high-deductible health plans can (now permanently) pay for telehealth services before the deductible is reached without affecting HSA eligibility. Similarly, direct primary care arrangements, in which a subscription fee covers a set of primary care services outside of insurance, are now compatible with HSA-eligible plans. These changes should broaden the patient pool for direct primary care and telehealth, providing marginal, but welcome, relief.
 
Three of the law’s other statutory changes are decidedly less generous. Charitable giving to health systems and other nonprofits may decline, as itemizers now face a one-percent net-income floor for claiming charitable deductions, and the top tax bracket now has a lower cap on the benefit of charitable deductions. The pipeline of future physicians will be affected by the new $200K lifetime cap on federal student loans for graduate students, as prospective students may choose not to pursue a medical education or take on private loans that alter their career choices after graduation. And finally, cuts to the Supplemental Nutrition Assistance Program (SNAP) will worsen food insecurity for millions of families, many of whom are also affected by Medicaid cuts, resulting in a less healthy population with worse health outcomes.