Fighting The Dangers of H.R. 1

Several weeks ago, H.R. 1 - or the "One Big Beautiful Bill Act" - passed the House. It details many changes across industries as diverse as energy, education, the military, taxes, and healthcare. The full text of the over one-thousand page bill is freely available here: https://www.govtrack.us/congress/bills/119/hr1/text.

Unless significant changes are made, this bill will do nothing short of devastate our already fragile healthcare system. If you work in the healthcare industry like me and, also like me, are busy with the day to day work of patient care and don't have time to read legalese for hours, I will offer you a brief summary.

First, though some in the house will say the bill is not a Medicaid cut, it truly is. As written, H.R. 1 would require every Medicaid recipient to recertify their eligibility every six months, something that places mountains of administrative burden on already taxed social workers and case managers and is sure to decrease the number of enrollees. It would also mandate that Medicaid recipients work, would make retroactive coverage once someone is enrolled only 30 days as opposed to the current 90 days, and would ban any Medicaid dollars from being used to pay "prohibited entities" - further reading goes on to essentially define these as family planning/Planned Parenthood clinics.

Second, though in certain ways it helps physicians get paid more through Medicare, it does nothing to address the 2.8% physician payment cut that went into effect at the beginning of 2025 nor does it protect Medicare from future cuts nor does it put into law any ongoing inflationary adjustment for such payments. Accounting for inflation, Medicare physician payments have seen a 29% decrease since the year 2001. For primary care providers like myself, it is becoming unaffordable to even see patients with Medicare.

Third, the bill makes all medical and dental students ineligible for Public Service Loan Forgiveness. The program, popular among those in healthcare, allows those working public service jobs (roughly equivalent to non-profit organizations) to pay back only a portion of their federal loans over 10 years and have the rest forgiven. Some may say physicians and dentists don't need loan forgiveness (after all they're rich, right!?), but the average doctor graduates with roughly $225,000 of debt and banning us from this program shuttles physicians and dentists to higher-paying, disproportionally urban jobs leaving already desperate rural regions of the country with even less providers.

On June 24th, myself and 320 other family doctors across 44 states went to Capitol Hill and spoke with our house and senate representatives. We expressed concern, frustration, and fear over what is in this wide-sweeping, ill-thought-out bill, just a sampling of which is outlined above. Urge your elected officials to let this bill die. Unless it is completely overhauled, it really is a choice of this bill dying or fellow Americans.