OBBBA Healthcare and Welfare Reforms
Key Questions
What are the key healthcare and welfare cuts proposed in OBBBA/HR1?
OBBBA/HR1 advances cuts to Medicaid, ACA, and SNAP totaling $1T over a decade, resulting in 7.5-11.8 million people losing coverage. It includes work requirements in states like Washington ($165M) and Arizona.
How does the FY27 HHS budget change under these reforms?
The FY27 HHS budget is proposed at $15B, representing a $911B reduction according to OMB's plan. Healthcare is highlighted as the biggest loser in the budget.
What reforms target 340B, ACCESS, PBM, and insulin?
The reforms address 340B fraud and the ACCESS program, alongside PBM changes and insulin pricing adjustments. 2026 PBM reforms under the Consolidated Appropriations Act aim to impact pharmacy benefit managers, though patient effects remain unclear.
What is HSA decoupling in the context of these reforms?
HSA decoupling reforms aim to give taxpayers more power over their healthcare dollars by improving flexibility in health savings accounts. This is positioned as a way for families to control spending during tax season.
What are the projected tax impacts of Trump year-one policies?
Trump-Republican tax policy in year one increases middle-income taxes by $900 while cutting top 1% taxes by $117B, adding $4.6T to the debt per ITEP. Permanent expensing boosts GDP by 0.7%.
What is the Democratic CAP proposal?
Democrats propose CAP with hospital and premium caps as a counter to reforms. A top Dem think tank unveils this as the next big health care push beyond undoing prior damage.
How do IRS cuts affect federal revenue?
IRS cuts contribute to $606B in federal tax gaps, with few states studying their own gaps despite billions at stake. Further IRS reductions and ACA tax surprises exacerbate revenue losses.
What is cited as a success model for tax policy?
North Carolina's decade of income and corporate tax cuts created nearly 450,000 private sector jobs, serving as a model per a Massachusetts study. Democrats are also making cases for targeted tax cuts on tips, overtime, and seniors.
OBBBA/HR1 advances Medicaid/ACA/SNAP cuts ($1T/dec, 7.5-11.8M lose cov) WA $165M/AZ work reqs; FY27 HHS $15B/-$911B; 340B fraud/ACCESS; PBM/insulin; HSA decoupling; Trump yr1 mid-class $900 hike top1% $117B cuts $4.6T debt (ITEP); permanent expensing 0.7%GDP; Dem CAP hospital/premium caps; IRS cuts/tax gaps $606B fed; NC success model. Dem/GOP tax pushes tips/OT/seniors.