Chandler Stisher retweetledi
The Senate version of the One Big Beautiful Bill Act (OBBA) raises a number of concerns for me. This legislation, in its current form, is really bad for family physicians, the future family medicine workforce, and is absolutely a red flag for rural health. Let’s look at 5 of the items that led me to this conclusion:
1. The bill in its current form, according to the Congressional Budget Office (CBO), would result in millions of people losing their current health care coverage through Medicaid and Marketplace plans – pushing the US uninsured above 10% of the population.
2. The bill does nothing to stabilize physician payments under the Medicare Physician Fee Schedule. In 2025, physicians experienced a 2.8% cut that has placed tremendous downward economic pressure on physician practices. This cut came on top of a decade where physician payments fell substantially behind inflation. Declining payments and rapid increases in practice costs for physician practices threaten access to care for patients and the sustainability of independent practices. The Senate has chosen to not address this critical issue, leaving millions of patients facing decreased access to primary care and specialty physician services.
3. The bill drops a popular primary care innovation that would potentially increase access to affordable care for millions of patients through direct primary care. The House provision allowed individuals/families to use HSA funds for the purposes of paying membership fees for a DPC practice – expanding access to affordable primary care.
4. The bill fundamentally changes the federal student loan and student loan forgiveness programs, creating new and substantial barriers to pursuing a medical education. This provision worries me significantly.
5. Rural advocacy organizations estimate that 18% to 20% of rural hospitals will close if the bill is enacted, further eroding the rural health ecosystem. Many family physicians provide services in these rural hospitals and their closure would result in poorer maternal mortality rates, longer distances for emergency services and a loss of jobs and stability for those communities – and decreased practice opportunities for family physicians to serve rural communities.
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