House bill would lead to provider revenue problems: Analysis

Provider revenue would take a massive hit if the House's reconciliation bill becomes law.

A recent analysis from the Robert Wood Johnson Foundation (RWJF) found that healthcare providers could see revenue losses of more than $770 billion over the next decade under the congressional spending bill passed by the House of Representatives.

The House bill, also known as the "One Big Beautiful Bill Act," was passed by a vote of 215-214 on May 22, 2025. The bill includes several healthcare-related provisions, including significant cuts to Medicaid and the expiration of subsidies for Affordable Care Act (ACA) Marketplace plans.

These cuts to public healthcare coverage options would result in millions more people becoming uninsured if the bill is enacted as it currently stands, RWJF researchers reported, citing numbers from the Congressional Budget Office (CBO).

At the time of publication, the number was an additional 15.9 million people becoming uninsured under the House bill. However, the CBO released a report on June 4, 2025, estimating 10.9 million more uninsured people by 2034 under the House bill.

With more uninsured people in the U.S., healthcare spending could drop by as much as $1.03 trillion between now and 2034, translating to lower provider revenue during the period, RWJF researchers reported.

According to the analysis, about 40% of the decline in healthcare spending would be on hospital services ($408 billion), 11% on office-based physician services ($118 billion), 26% on other healthcare services ($272 billion) and 23% on prescription drugs ($234 billion). Three-quarters of the total reduction in healthcare spending is attributable to provisions in the reconciliation bill, RWJF researchers added.

Additionally, healthcare providers would see a significant uptick in uncompensated care costs.

The analysis estimated a $278 billion increase in uncompensated care sought by uninsured people from 2025 to 2034, with the burden mostly on hospitals. Hospitals would see uncompensated care costs increase by about $83 billion, while physician practices and other providers would see a $34 billion and $107 billion increase, respectively.

Uncompensated care costs for prescription drugs would also grow by as much as $54 billion during the period, the analysis showed.

About 72%, or $198 billion, of the increase in uncompensated care during the period is attributable to the provisions in the reconciliation bill, and 28%, or $78 billion, is attributable to the expiration of the enhanced ACA Marketplace subsidies.

The loss of provider revenue coupled with higher uncompensated care costs would have significant adverse consequences, particularly for rural hospitals and other financially at-risk healthcare organizations, RWJF researchers explained.

"Losses in revenue could put more hospitals at risk, potentially leading to large increases in rural hospital closures," they wrote in the analysis. "Alongside negative spillover effects on the local economy, hospital closures could reduce access to and use of hospital services, increasing the mortality risk for heart attacks, unintentional injuries, and time-sensitive conditions."

A recent report from the Center for Healthcare Quality and Payment Reform found that about one-third of rural hospitals in the U.S. are at risk of closing.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.