By: Andrew Mackenzie, Chief Science Officer at Arbital Health
| The recently passed One Big Beautiful Bill Act (BBB) introduces a wide array of regulatory changes that will shape healthcare for years to come. It brings particularly important implications for value-based care (VBC) stakeholders. From new rules for Medicaid and Marketplace plans to expanded Health Savings Account (HSA) eligibility and a substantial new investment in rural health, this bill touches almost every corner of the healthcare landscape. |
Even if your organization doesn’t take much Medicaid risk today, these reforms could still impact your VBC contracts—and we’re here to help you adjust confidently.
Let’s break this down.
Medicaid: Big Adjustments Ahead
Commercial & ACA Marketplace Plans: Tighter Rules, Expanded Tools
Medicare: Changes to Eligibility and Payment Rates
Rural Health: A New Opportunity
These rule changes will likely result in large reductions in Medicaid enrollment as well as Commercial exchange enrollment. According to the Congressional Budget Office, these changes will result in roughly 11 million additional uninsured individuals by 2034. This represents a ~10% reduction in membership in both Medicaid and Commercial Exchange enrollment.
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For organizations taking Medicaid or Commercial Exchange risk, these membership changes translate into fewer covered lives, changing risk pools, and financial implications that will require thoughtful repricing and contract design for VBC arrangements to handle changes in risk profile. Outside of direct membership loss, uninsured individuals can still receive treatment from emergency rooms and hospitals. If they lack access to appropriate preventative care, this can spiral into large avoidable events like ER visits for untreated diabetes, CHF, or CKD among many others. These costs could cascade into the commercial market as hospitals adjust their fee schedules, pushing up medical trend and impacting commercial VBC contracts. As such, we also encourage appropriate pricing and trend adjustments to be made in Commercial VBC deals as well. |
The expanded eligibility and use of HSAs—including coverage for Direct Primary Care (DPC) and the elimination of deductibles for telehealth—will likely give a strong boost to DPC initiatives, HSA administrators, and virtual care providers. DPC is inherently a form of value-based care, and this policy change is expected to drive significant growth and innovation in DPC-centered healthcare solutions. As adoption accelerates, particularly among self-insured employers and fully insured commercial markets, organizations will need new risk arrangements and updated pricing strategies to support this momentum.
The Rural Health Transformation Program creates significant new opportunities for rural providers to launch innovative VBC programs with support of Federal funding.
We know navigating policy shifts like BBB can feel complex—but we’ve got you covered.
| At Arbital Health, we help clients design, price, monitor, adjudicate, and optimize VBC contracts so you can stay ahead of these changes with confidence. Whether you’re a DPC provider, telehealth company, rural health system, specialist, payer, employer, or enabler in Medicare, Medicaid, or Commercial markets, our actuarial-powered platform and VBC expert advisory services can help ensure your contracts reflect the latest regulatory landscape. |
Here’s how we help you thrive in this new environment:
Our team of expert VBC actuaries and our actuarial-powered platform take care of the complexity—so you don’t have to. Let us help you design, price, and manage contracts that reflect this evolving landscape.
We’re ready to help you stay ahead.