The Affordability Crisis
The One Big Beautiful Bill (OBBBA), signed in 2025, reshaped the American healthcare safety net. It ended the enhanced ACA premium subsidies, imposed new Medicaid work requirements, and capped state funding mechanisms — a combination projected to strip coverage from millions while raising costs for the households that keep it. Here's how the pieces fit together and why Americans are getting squeezed.
How the bill squeezes patients
Three provisions converge on one outcome: Americans pay more for care, and millions lose coverage entirely.
One Big Beautiful Bill (2025)
Healthcare provisions in the budget reconciliation law
ACA subsidies end
Enhanced premium tax credits expire Dec 31, 2025
Medicaid work rules
80 hrs/month + redeterminations every 6 months
State provider-tax cap
Squeezes state Medicaid funding
Americans squeezed
Higher premiums, lost coverage, bigger out-of-pocket bills
The squeeze: The bill ends the enhanced ACA subsidies that had capped premium costs for marketplace enrollees, while new Medicaid work requirements and redeterminations push millions off coverage. With fewer people insured and subsidies gone, the same medical care costs households more — at exactly the moment executive pay at the largest insurers keeps climbing.
Why it hurts affordability
Enhanced ACA subsidies expire
The Inflation Reduction Act temporarily boosted premium tax credits so marketplace enrollees paid no more than ~8.5% of income. The Big Beautiful Bill lets them lapse at the end of 2025 — a 40-year-old earning $50K could see premiums roughly double in 2026.
Medicaid work requirements
New 80-hour/month reporting rules and more frequent eligibility redeterminations (every 6 months) create paperwork hurdles that cause eligible people to lose coverage simply for failing to keep up with paperwork.
State provider-tax caps
Capping the provider taxes states use to fund their Medicaid share forces states to cut benefits, reduce payments to safety-net hospitals, or shrink enrollment.
Coverage loss compounds cost
When people lose insurance, they delay care until it becomes an emergency — the most expensive setting. Uncompensated care rises, hospitals shift costs to the privately insured, and premiums climb further for everyone.
Why this dashboard tracks it: The same insurers and pharmaceutical companies whose executive pay we document here are the ones setting the premiums, copays, and formulary rules that the Big Beautiful Bill leaves intact. When public subsidies shrink and coverage narrows, the gap between what executives take home and what families can afford widens further.
Disclaimer: For educational and informational purposes only. This dashboard aggregates publicly available data from IRS Form 990 filings and third-party sources; figures may be incomplete, estimated, or out of date. Nothing here constitutes legal, financial, tax, or medical advice, or an endorsement or judgment of any organization or individual. Always verify with official filings and qualified professionals before relying on any figure.