As the One Big Beautiful Bill Act is set to make changes to Medicaid eligibility and financing in 2026, many health systems are bracing for the financial strain and administrative burden that could result.
Becker’s spoke with four healthcare strategic leaders about how they feel OBBA will impact their health system and the steps they are taking to prepare.
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Editor’s note: Responses have been lightly edited for length and clarity.
Question: How do you think OBBBA will impact your organization in 2026?
Alan Kumar, MD. Chief Operating Officer, Powers Health (Munster, IN): Indiana hospitals currently are reimbursed 57 cents for every dollar spent to provide care to Indiana Medicaid patients. Less reimbursement will lead to larger losses and result in patient access issues. Increased uncompensated care will put more stress on the emergency departments to become the provider of last resort for many patients. Delayed care will lead to more complications and a generally less healthy population.
Joshua Michalski. Chief Operating Officer, Kettering Health (Kettering, OH): For health systems in Ohio, the OBBBA means reduced CMS reimbursement layered on top of already low Medicaid rates set by the federal budget. While all parties agree on the importance of reducing healthcare inflation, reducing Medicaid eligibility does not change the health system’s responsibility to care for the population. Instead, it converts Medicaid patients to self-pay status, further shifting the financial burden to commercial payers to offset the aggregate cost of care.
Enhanced Medicaid payments will be the determining factor for the financial health of Ohio’s health systems. The OBBBA also offers minimal long-term incentives for rural health—an area that is already disadvantaged. Despite these long-term challenges, Kettering Health has reaffirmed its commitment to Ohio’s rural populations through the development of new small health centers designed to integrate primary care, acute care, and specialty services. This model provides patients with a higher level of service at a reduced cost, which is especially critical in rural communities.
Overall, the OBBBA is pushing our organization to innovate—optimizing technologies, leveraging provider and clinician resources, embracing integrated care models instead of siloed approaches, and eliminating all low-value cost areas.
Brian Evans. Chief Operating Officer, Optim Health System (Savannah, GA): We’re monitoring the One Big Beautiful Bill Act and evaluating the potential operational implications for our system. The American Hospital Association has provided important context on how the legislation could affect patient coverage, hospital reimbursement, and rural access to care. We will continue to rely on the AHA’s analysis as implementation details become clearer and will adapt accordingly to ensure continuity of care in our communities.
Dawn Thompson. Chief Strategy Officer, Advanced Diagnostics Healthcare System (Houston, TX): Model exposure – scenario modeling…. we have to look at how much of our model comes from Medicaid, state-directed payments, charity/uninsured…. etc., and be ready to pivot.
Diversity Payor Mix – grow service lines with higher commercial payors and outpatient services with high margins. We work with self-funded organizational benefits programs. This can enhance cash flow, revenue cycle efficiencies, cost savings for patients and employers, and be lucrative for Hospitals.
Efficiency and Cost control, Service line review….all of these are important to explore through the changing terrain of healthcare.
We feel well positioned with a strong commercial payer mix….some of the rural markets may not be positioned as well.
