On July 4, President Trump got his wish and was able to hold a signing ceremony for the Reconciliation Bill that put into effect many of his policy priorities.

The “One Big Beautiful Bill Act”, H.R. 1, was thus made law after the House of Representatives underwent hours of holding open votes, and a marathon speech from Democratic leader Hakeem Jeffries (D. N.Y.), to concur in the Senate amendment to the bill. That amendment was substantially different from the version that was sent over from the House at the end of May. We covered the basics of the initial House version in an earlier blog post.

We will have more in depth explorations of what changes this law will bring on the health law universe, and they are going be extensive. However, here is a quick highlight of the areas of health care law that were included (and those that were left out).

Medicaid and CHIP

This is where the greatest impact of the change in law will be felt. As with the House version, recent eligibility regulations are under a moratorium until 2034. The law also changes eligibility requirements for Medicaid beneficiaries, including adding “community engagement” requirements and increasing frequency of reverifications.

The law also placed a more stringent cap on the ability of states to fund their portions of the Medicaid program by charging provider taxes.

Long Term Care and Nursing Home Staffing

As with the House version, the final approved Senate version places a moratorium on the Biden Administration’s Long Term Care and Nursing Home staffing rule. The rule has been enjoined by a district court, but now, by law, the government is prevented from enforcing the rule until 2034.

Abortion and Gender Affirming Care

This was one of the biggest changes between the two versions. The House version had a prohibition on cost-sharing reduction payments to qualified health plans that provided coverage for abortion as well as a prohibition on Medicaid and CHIP coverage for gender transition procedures.

The prohibition on gender transition procedures was removed from the Senate version and the abortion restrictions were changed to a prohibition on Medicaid payments to any provider who also provides abortion care.

Regulation of Pharmacy Benefit Managers

The final Senate version of the bill dropped the original House bill’s regulation of pharmacy benefit managers (PBMs) because the Senate parliamentarian ruled that the provision violated the Senate’s rules for reconciliation.

This continues the recent trend of legislation that has attempted to regulate PBMs having those provisions stripped out at the last minute.

Physician Fee Schedule

The House bill proposed substantial changes to the conversion factor calculations under the Medicare Physician Fee Schedule. Among those changes were elimination of the two-track conversion factor that is supposed to take effect in 2026 and will provide Alternate Payment Model participants with a different conversion factor. Additionally, the House bill proposed to update the 2026 conversion factor based on the Medicare Economic Index and then tie future conversion factors to that number.

However, the final version of the law didn’t include those provisions. Instead the law included a 2.5 percent increase in the conversion factor for 2026.

As noted above, this is a short summary of some of the major changes and differences that the Senate bill will bring to health law. Over the course of the next two weeks, we will bring you much more in depth analysis of each of these provisions and other aspects that will impact health law. If you have any questions please do not hesitate to reach out to the health care lawyers at Reed Smith.