Challenges Ahead: How OBBBA and Expiring Tax Credits Could Hurt Americans’ Health Coverage

The One Big Beautiful Bill Act, which was signed into law on July 4, 2025, includes significant changes to Medicaid and the insurance exchange marketplaces that are expected to leave millions of Americans uninsured and significantly reduce resources available to fund care. 

In addition to the sweeping changes coming to health care, the enhanced premium changes that help hardworking Americans afford to buy their own health coverage from the exchanges are set to expire at the end of the year, which could leave as many as 5 million more Americans uninsured and lead to premiums skyrocketing for millions more. These impacts add insult to injury on 24/7 hospital care that is already stretched thin.

In this episode, Chip Kahn welcomes Dr. Fred Blavin, a senior fellow at the Urban Institute, to explore Urban’s studies on how the OBBBA and the expiration of the enhanced tax credits could exacerbate challenges facing uninsured Americans and add to the uncompensated care hospitals will have to shoulder in the years ahead. 

Key topics include: 

• The health measures included in the “One Big Beautiful Bill Act”
• The impacts the expiration of the enhanced premium tax credits would have on America’s uninsured rate and the health systems who provide all patients with critical care. 
• The need for Congress to keep affordable access to coverage available and extend the tax credits. 

Studies relevant to the conversation: 

The Urban Institute: “Rural Hospital Revenue Could Drop by $87 Billion over 10 Years Because of the Reconciliation Bill and Expiring Enhanced Tax Credits”

The Urban Institute: “State-Level Estimates of Health Care Spending and Uncompensated Care Changes under the Reconciliation Bill and Expiration of Enhanced Subsidies”

Guest Bio: 

Dr. Fred Blavin is a Senior Fellow and leads the Low-Income Coverage, Access, and Affordability Practice Area in the Urban Institute’s Health Policy Division, where he specializes in health economics and policy research. He has extensive experience leading the design and the evaluation of state and federal policies related to medical debt, health care reform, Medicaid, income and benefits, and health information technology. His research incorporates diverse topics including medical debt and affordability, hospital finances, provider consolidation, health care spending and prices, and how public policy choices affect consumers, providers, and health insurance markets. He is an author of over 80 policy reports and 30 peer-reviewed articles in a variety of economic, policy, and medical journals. Dr. Blavin’s research has been featured in numerous local and national media outlets, such as the New York Times, USA Today, Wall Street Journal, Washington Post, Marketplace, Forbes, CBS News, and Kaiser Health News.