If you’ve heard of the One Big Beautiful Bill Act, also known as H.R. 1, you’ve probably heard about changes it’s made to healthcare reimbursements. Over the last few months, special interests have spent a great deal of time scaring the public about what this might mean for the future of their healthcare. There’s no reason to be scared. H.R. 1 protects Medicaid, strengthens our healthcare system, and will ensure that our most vulnerable citizens continue to access the healthcare they need for years to come.
The first thing people should know about H.R. 1 is that the bill only made changes to Medicaid and not Medicare eligibility. As I’ve had conversations with people, there’s been some confusion on this front. The names are similar, so here’s how to distinguish the two programs: Medicare serves people 65 and older and is an entitlement that working Americans pay into. I’ll repeat myself: H.R. 1 made no changes to eligibility for Medicare.
Medicaid is a distinct program that was originally designed to serve Americans with disabilities and other vulnerable individuals. Over the last several years, because of Obamacare, the program has been expanded to include able-bodied, working-age Americans. Some states have even attempted to give people who came to the United States illegally access to Medicaid. Since 2010, spending on Medicaid has more than doubled from $420 billion to $900 billion by the end of fiscal 2023. This comes at the same time as America’s national debt continues to grow, recently topping $37 trillion.
H.R. 1 makes some key changes to Medicaid eligibility to ensure that the program continues to serve the most vulnerable. First, it stops states from giving Medicaid to people who broke our laws when coming to America. Second, it puts common-sense work requirements in place to receive Medicaid. These requirements only apply to able-bodied, working-age Americans who do not have young dependents. Third, it requires more regular eligibility checks to ensure you qualify for the program.
These reforms are designed to restore fiscal discipline, promote work, and empower states, reflecting our country’s core values of personal responsibility, limited government, and respect for your taxpayer dollars. They are not designed to affect our most vulnerable Americans who rely on Medicaid.
As H.R. 1 made changes to Medicaid, Congress worked to ensure that rural hospitals, which often face the greatest financial challenges, were protected. The bill established a $50 billion fund for rural hospitals called the Rural Health Transformation Fund. This fund will help support hospitals that are providing critical care in the most remote regions of America. This includes allowing these healthcare facilities to use these funds to recruit and retain their workforce — something desperately needed in rural America to ensure access to care.
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Medicaid programs have traditionally varied from state to state. Even after H.R. 1, Medicaid programs will continue to be tailored to each state’s needs. For example, my home state of Nebraska recently signed an agreement with the federal government establishing a State Directed Payment program, an agreement that I personally worked to secure approval for from the Centers for Medicare and Medicaid Services. Many states already use this tool to draw down more federal funds for their Medicaid programs. Thanks to the agreement, Nebraska will see about $700 million more in Medicaid funding. Nebraska’s hospitals are receiving a critical lifeline for both rural and urban communities thanks to these resources.
This is a snapshot of the wide-ranging changes H.R. 1 made to strengthen Medicaid. As these reforms unfold in the coming years, they will help ensure that Medicaid continues to provide critical healthcare to millions of Americans who need it the most. With the One Big Beautiful Bill Act and its Medicaid reforms now law, we’re ensuring the program delivers on its original mission: to help those in need bounce back stronger, protect taxpayer dollars, and safeguard the future of American healthcare.
Congressman Mike Flood represents Nebraska’s First Congressional District. He is the chairman of the Republican Main Street Caucus and a member of the House Financial Services Committee.