CEO: One Big Beautiful Bill Act
October 29, 2025
(Published as a Letter to the Editor in The Carrollton Democrat)
By Scott Thoreson, Carroll County Memorial Hospital Chief Executive Officer
Hospitals and other healthcare-related organizations are working to identify the impact of the “One Big Beautiful Bill Act” (OBBBA) that was signed by the President on July 4. While the name may sound promising, the reality is more complicated, especially for rural communities like ours.
Included in this legislation were reductions to Medicaid program spending by approximately $1 trillion and other measures that ultimately will lead to increases in the national debt over the next 10 years to the tune of $3 trillion as determined by the Congressional Budget Office. The changes contained in the OBBBA are scheduled to be implemented over the next number of years ending in 2034.
The federal government will be reducing the formula in which they cost-share with the state government to fund the Medicaid program. States will need to determine if they want to increase the state’s share of Medicaid funding, which could increase the amount of taxes that states generate. Conversely, states could further limit eligibility which would reduce the number of people that could be covered by Medicaid.
I have been sharing with our Carroll County Memorial Hospital (CCMH) Board of Directors that we are concerned about this legislation for a few different reasons and watching it closely. About 20 percent of our patient revenue comes from Medicaid. Any cuts to that funding will hit us hard and, by extension, hit our community hard.
We are also concerned about the future of the Accountable Care Act (ACA) and the marketplace that was established to provide coverage for uninsured families. If the ACA premium tax credits are not extended beyond their expiration on December 31, 2025, the cost of premiums will explode. For example, an average family of four making $64,000 would have their premiums increase by $2,600 annually. It gets even worse for a 60-year-old couple with an income of $80,000 as their annual premiums would increase by $17,500 annually. Assuming that these same individuals then choose to go without coverage, it would be likely that they will not seek care and their conditions would worsen before they came to the clinic or hospital. CCMH would certainly see more patients unable to pay, which strains our ability to serve everyone.
A provision called the Rural Health Transformation Program was also included in the OBBBA that would provide $50 billion over 5 years to: 1. Make rural America healthy again; 2. Provide for sustainable access; 3. Address workforce development; 4. Spark innovative care; and 5. Encourage technological innovation. The states are applying for these funds, and Missouri is working diligently to meet the tight timelines this year to determine funding decisions for early 2026. While $50 billion does sound like a lot of money, it only amounts to 37 percent of the funding that was cut by the same legislation.
I hope this article has provided a bit more of an insight into concerns that CCMH has as an organization about the One Big Beautiful Bill Act and how that will impact our area residents. We will continue to stay on top of changes and always strive to meet patient needs. I wish you good health!
More in this Series:
CEO: Growing the Next Generation (Published July 16, 2025)
https://www.carrollcountyhospital.org/news/ceo-growing-the-next-generation
CEO: National Hospital Week 2025 (Published May 14, 2025)
https://www.carrollcountyhospital.org/news/ceo-national-hospital-week-2025
CEO: Advance Directives (Published April 14, 2025)
https://www.carrollcountyhospital.org/news/ceo-advance-directives
CEO: Health Insurance Decision Time (Published September 25, 2024)
https://www.carrollcountyhospital.org/news/ceo-health-insurance-decision-time
CEO: Hospital Week 2024 (Published May 13, 2024)
https://www.carrollcountyhospital.org/news/ceo-hospital-week-2024
CEO: Community Health Needs Initial Assessment (Published April 24, 2024)
https://www.carrollcountyhospital.org/news/ceo-community-health-needs-initial-assessment
CEO: Cybersecurity (Published February 14, 2024)
https://www.carrollcountyhospital.org/news/ceo-cybersecurity
CEO: End of Year Reflections (Published December 29, 2023)
https://www.carrollcountyhospital.org/news/ceo-end-of-the-year-reflections
CEO: Coding Matters (Published November 22, 2023)
https://www.carrollcountyhospital.org/news/ceo-coding-matters
CEO: Maternity Care Desert (Published October 25, 2023)
https://www.carrollcountyhospital.org/news/ceo-maternity-care-desert
CEO: Rural Emergency Hospitals (Published September 20, 2023)
https://www.carrollcountyhospital.org/news/ceo-rural-emergency-hospitals
CEO: Primary Care Provider (Published August 23, 2023)
https://www.carrollcountyhospital.org/news/ceo-primary-care-provider
CEO: Supply Shortages (Published June 28, 2023)
https://www.carrollcountyhospital.org/news/ceo-supply-shortages
CEO: CCMH Named Top 20 Critical Access Hospital (Published June 14, 2023)
https://www.carrollcountyhospital.org/news/ceo-ccmh-named-top-20-critical-access-hospital
CEO: Hospital Week 2023 (Published May 3, 2023)
https://www.carrollcountyhospital.org/news/ceo-hospital-week-2023
CEO: Prior Authorizations (Published April 5, 2023)
https://www.carrollcountyhospital.org/news/ceo-prior-authorizations
CEO: Staff Shortage and Open Positions (Published February 8, 2023)
https://www.carrollcountyhospital.org/news/ceo-staff-shortage-and-open-positions
CEO: End of Year 2022 (Published December 14, 2022)
https://www.carrollcountyhospital.org/news/ceo-end-of-2022
CEO: Purpose of the Foundation (Published November 10, 2022)
https://www.carrollcountyhospital.org/news/purpose-of-the-foundation
CEO: Health Insurance Portability and Accountability Act (Published September 28, 2022)
https://www.carrollcountyhospital.org/news/ceo-health-insurance-portability-and-accountability-act
CEO: CCMH Providers (Published August 24, 2022)
https://www.carrollcountyhospital.org/news/ceo-ccmh-providers
CEO: Financial Assistance (Published July 20, 2022)
https://www.carrollcountyhospital.org/news/ceo-financial-assistance
CEO: Social Determinants of Health (Published June 29, 2022)
https://www.carrollcountyhospital.org/news/ceo-social-determinants-of-health
CEO: National Hospital Week (Published May 11, 2022)
https://www.carrollcountyhospital.org/news/ceo-national-hospital-week
CEO: Why Healthcare is Expensive (Published May 4, 2022)
https://www.carrollcountyhospital.org/news/ceo-why-healthcare-is-expensive
CEO: A Hospital is Still a Business (Published March 16, 2022)
https://www.carrollcountyhospital.org/news/ceo-a-hospital-is-still-a-business
CEO: Different Types of Hospital Ownership (Published February 1, 2022)
https://www.carrollcountyhospital.org/news/ceo-different-types-of-hospital-ownership
CEO: Holiday Message (Published December 20, 2021)
https://www.carrollcountyhospital.org/news/ceo-holiday-message