The One Big Beautiful Bill, signed into law by President Trump on 4th July 2025, represents one of the most sweeping overhauls of US healthcare this century. The law reshapes the Affordable Care Act, Medicaid, and Medicare through stricter eligibility checks, work requirements, and expanded health savings accounts. While the government billed it as a plan to improve efficiency and reduce costs, its rollout has been described by many healthcare workers as burdensome and confusing.
A new survey from healthcare platform Tebra, involving over 900 patients and providers, reveals a widening gap between policy promises and real-world experiences. The report finds growing fear, rising paperwork, and declining confidence in the system.
According to the Congressional Budget Office, the reforms could leave 16 million more people uninsured by 2034, including 7.8 million due to Medicaid changes. Enhanced premium tax credits under the Affordable Care Act are also set to expire at the end of 2025, potentially adding five million more to the uninsured population. Tebra’s data aligns with these projections, indicating widespread anxiety about affordability and access.
Uncertainty over access and finances
As the law transitions from policy to practice, its effects are reshaping how patients and providers interact.
- 67% of patients worry they may lose access to medications, vaccines, or ongoing treatment.
- 40% now feel more at risk of medical debt or bankruptcy.
- 68% of providers believe the bill harms vulnerable groups.
These figures reflect a system facing administrative strain. The new rules remove automatic re-enrolment for marketplace subsidies, forcing 11 million people who previously relied on passive renewal to re-verify eligibility each year. Open enrolment has been shortened to 1 November through 15 December, excluding many late sign-ups. Medicaid block grants and fraud-reduction initiatives, while intended to cut costs, could reduce state funding by $1 trillion over the next decade.
A KFF poll from June 2025 found two-thirds of Americans view the bill unfavourably, with sentiment worsening when respondents learn of its potential health impacts. Medicaid’s overall popularity has reached 83%, highlighting resistance to the reforms.
Impact on care and communication
On the provider side, administrative demands have grown significantly.
- 43% report that patients are skipping or delaying care due to coverage confusion.
- 46% say paperwork and documentation have increased.
- Nearly three-quarters have received no official guidance on how to implement the changes.
These challenges affect both efficiency and patient health. Missed preventive visits and untreated chronic conditions are becoming more common. The new rural health programme, funded with $50 billion over five years, aims to support state-level innovation, but with 2,086 rural hospitals relying on $12.2 billion in annual Medicaid revenue, experts warn that even small shortfalls could worsen service delays.
The National Academy for State Health Policy notes that states must now update systems for residency and immigration verification, adding complexity without clear federal direction.
How practices can respond
Tebra’s report suggests that private practices can reduce confusion through plain-language communication, upfront eligibility checks, and centralised patient messaging. Integrating clinical, billing, and communication tools can also help streamline operations. Tebra, which supports over 150,000 providers, highlights how automation and telehealth integration can offset the administrative burden while improving access.
The One Big Beautiful Bill promised simplification, yet the early evidence shows increased confusion and strain. As 2026 approaches, the long-term effects remain uncertain. What is evident is that patients feel less secure and providers less supported. For many Americans, navigating healthcare has become more difficult.
Still, with clear communication and efficient systems, private practices have an opportunity to restore some stability and trust: a goal that may ultimately prove to be the bill’s most meaningful success.