A Mini Public Health Review of the "One, Big, Beautiful" Bill
Image Source: WhiteHouse.gov
The "One Big Beautiful Bill" (OBBB), recently passed by Congress, is a sweeping legislative package covering nearly every corner of American policy. From agriculture to defense to healthcare, the bill is more than 1000 pages long. While it has sparked political debates for its economic and regulatory implications, let’s review some of the public health topics mentioned in the bill.
Nutrition Policy: SNAP Reforms and Food Access
1. Redefining the Thrifty Food Plan
The bill revises the basis for SNAP (formerly known as food stamps) benefit calculations. The USDA will use a stricter formula that ties benefit increases to inflation only every 5 years, with a requirement that changes be cost-neutral.
What it means: This could limit how much assistance vulnerable families get to buy healthy food, especially during periods of rapid food inflation.
2. Work Requirements for Able-Bodied Adults Without Dependents (ABAWDs)
The age range subject to SNAP work requirements is expanded to 18–65. Waivers for exemptions (e.g., in high unemployment areas) are now harder to get.
Impact: These changes could reduce SNAP enrollment, particularly in rural or economically distressed communities, possibly increasing food insecurity.
Medicaid and Healthcare Access
3. Eligibility Tightening and Address Verification
States must now frequently re-check Medicaid recipients' eligibility. Deceased individuals and those lacking verified immigration status will be automatically unenrolled.
Risk: While aimed at reducing fraud, this may also accidentally or unintentionally unenroll eligible individuals, especially those with unstable housing or inconsistent mailing addresses.
4. New Work Requirements for Medicaid
States will be required to impose community engagement or work requirements on certain adult Medicaid recipients.
Public health lens: These policies have historically led to coverage losses without increasing employment, disproportionately affecting low-income adults with mental or physical health challenges.
Preventative Care and Health Savings Accounts
5. More Flexibility for Health Savings Accounts (HSAs)
The bill allows seniors on Medicare Part A to contribute to HSAs and broadens what can be reimbursed—including gym memberships and fitness activities.
Upside: Encourages preventative health behavior.
Downside: Benefits those who are already well-off enough to save in HSAs, leaving out low-income Americans.
Rural Health Investment
6. Expanding the Definition of Rural Emergency Hospitals
The OBBB includes a provision to expand what qualifies as a rural emergency hospital under Medicare, enabling more facilities to receive federal funding.
Positive: Could bolster access to care in underserved rural regions—especially critical as many rural hospitals are closing.
Public Health Programs: Cuts and Repeals
7. Repeal of the National Education and Obesity Prevention Grant
This program funded healthy eating and physical activity initiatives, especially in low-income communities.
Effect: The elimination may limit community-level interventions targeting obesity, diabetes, and other chronic diseases.
Gender and Reproductive Health
8. Federal Ban on Medicaid Funding for Gender Transition Procedures
The bill prohibits federal Medicaid and CHIP funding for gender-affirming care, including hormone therapy and surgeries.
Impact: May create access barriers for transgender individuals, potentially impacting mental health and continuity of care.
Drug Pricing and Access to Orphan Drugs
9. Orphan Drug Carveouts
The bill prevents certain rare disease drugs (orphan drugs) from being included in Medicare’s drug price negotiation program.
Pros: Could encourage more investment in rare disease drug development.
Cons: Could also limit cost-saving measures and keep orphan drug prices high.
Medicaid Fraud and Pharmacy Accountability
10. Crackdown on Spread Pricing
The bill bans spread pricing—a practice where pharmacy benefit managers (PBMs) charge Medicaid more than they pay pharmacies.
Outcome: A step toward greater transparency and possibly lower Medicaid drug costs.
Immigration and Health Equity
11. Restrictions on Medicaid for Undocumented Immigrants
Medicaid and CHIP funding will now be prohibited for any individual without verified immigration status.
Concern: May widen health disparities for immigrants, and increase use of emergency rooms for care, which is costlier and less preventive.
Technology, AI & Public Health Oversight
12. AI Tools for Medicare Audits
The bill includes a mandate for AI implementation to detect and recover fraudulent Medicare payments.
Insight: Could streamline oversight and save taxpayer money, but algorithm bias and errors in targeting vulnerable populations are major concerns.
Final Thoughts: A Balancing Act
The One Big Beautiful Bill is a mixed bag for public health. On one hand, it invests in rural health, tightens Medicaid oversight, and promotes preventative care through HSAs. On the other, it raises major concerns about access, equity, and coverage losses—especially for marginalized groups.
As this bill rolls out, public health experts and advocacy groups will need to monitor:
Health equity impacts
SNAP-related food insecurity rates
Coverage shifts due to Medicaid redeterminations
Rural hospital financial health
Mental health implications for vulnerable populations
Source:
https://www.congress.gov/bill/119th-congress/house-bill/1/text