The One Big Beautiful Bill Act, nicknamed the “Big Beautiful Bill,” includes sharp cuts to health care spending via changes to Medicaid, which Congress approved last week.
Nearly 3 million Ohioans receive Medicaid coverage, according to the Ohio Department of Medicaid. As of May, more than 760,000 Ohioans receive coverage through the expansion of Medicaid.
The state budget that was signed by Gov. Mike DeWine last week created a “trigger” to pull Ohio out of Medicaid expansion if federal lawmakers reduced their share of spending for that program. While reducing the federal share was proposed, it was not included in the final federal budget bill, so that “trigger” is in state law but wasn’t pulled.
Over the next decade, enrollment in the public health insurance program could decrease nationwide by between 307,000 to 511,000 recipients because of the federal spending bill, according to early June estimates by KFF, a nonprofit health policy organization.
Under the federal spending bill, Ohio hospitals could see a decrease of billions of dollars in health care spending due to the reduction in Medicaid coverage, according to a state-by-state analysis by the Robert Wood Johnson Foundation (RWJF), a health research nonprofit organization.
The bill also does not include an extension of the enhanced premium tax credits (PTCs) for the Affordable Care Act marketplace plans, which are set to expire at the end of this year. The expiration of these credits will result in the loss of coverage for an additional 4 million individuals, the analysis says.
Ohio hospitals could also see an additional $2 million in health care spending losses from the non-renewal of the enhanced PTCs.
This loss of coverage means many individuals will likely avoid seeking medical care at the expense of their immediate and long-term health, according to Dr. Vikas Saini, president of the Lown Institute, a health care think tank.
“If the cuts to Medicaid go through, more Americans will lose coverage. They’ll have to choose between going into medical debt or simply not getting the care they need. People will get sicker and some will die of preventable causes,” Saini said.
The projected spending losses would also jeopardize the health of hospital systems themselves, Saini adds.
“Similarly, all hospitals, but especially those primarily serving working class or rural communities, will be very strained financially, and more of them will be at risk of shutting down,” he said. “This is a moment to fix the imbalances in our health care system, not make them worse.”
The loss of insurance for millions of individuals will also lead to an increase in uncompensated care, which are health care services for which hospitals receive no payment, the RWJF analysis says.
This includes medical bills acquired by patients who are either unable or choose not to pay.
In Ohio hospitals, uncompensated care totals are expected to rise over the next decade by more than $2 billion under the bill.
The Greater Dayton Area Hospital Association (GDAHA) stressed the potential that any significant cuts to Medicaid could limit access to preventative and emergency care for some of Ohio’s at-risk individuals.
“Hospitals in the greater Dayton area rely on federal programs that cover the cost of providing care, such as Medicare, Medicaid and the Health Insurance Marketplace. These payment programs provide consistent, coordinated access for patients, and are essential for vulnerable members of our community – such as children, those with disabilities and families and seniors with limited means," the organization said in a statement on behalf of itself and local hospital networks Kettering Health and Premier Health.
“Sustained coverage ensures patients can get the care they need, when they need it and at the most appropriate location for their specific health needs,” the GDAHA statement continues. “The Greater Dayton Area Hospital Association and our member hospitals remain committed to working with our federal delegation to ensure they are aware of the health needs of the greater Dayton area and how cuts to these vital programs would impact our community’s health, the economic vitality of our region and the stability of providing health care services.”
Reporter Samantha Wildow contributed to this story.
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