Understanding the Health Policy Impact of the 2025 One Big Beautiful Bill Act (OBBBA): PCG Summaries of Medicaid & Marketplace Related Provisions

On July 4, 2025, the administration signed into law 2025 HR 1 or more widely known as the One Big Beautiful Bill Act (OBBBA). This legislative package introduces significant reforms across multiple areas of the U.S. healthcare system, including Medicaid-related provisions, which are detailed in Title VII of the Act and span 21 distinct sections (71101 through 71121), and commercial insurance/Marketplace-related provisions, which are detailed in eight sections (71301 through 71308).  

To help stakeholders navigate these complex changes, Public Consulting Group (PCG) has prepared a comprehensive two-part summary of the healthcare provisions in OBBBA, integrated with key points from the Final Marketplace Integrity and Affordability final rule. These summaries include key implementation dates, projected fiscal impacts as estimated by the Congressional Budget Office (CBO), and details on federal funding appropriated to the Centers for Medicare & Medicaid Services (CMS) and to states for implementation. 

It’s important to note that OBBBA also includes the creation of a Rural Hospital Transformation Program. This initiative allocates $50 billion over five years (2026–2030) to improve healthcare access and outcomes in rural communities, signaling a broader commitment to addressing disparities in healthcare delivery across the country. 

What to Expect in This Two-Part Summary Write Up:

Part One addresses Medicaid-related provisions. 

• • The full Summary can be found here.  

Part Two addresses commercial insurance/Marketplace related provisions. 

• • The full Summary can be found here. 

These summaries aim to provide Medicaid agencies, healthcare providers, and policy professionals with a clear and actionable understanding of the changes ahead.