The year 2025 has brought significant changes to the healthcare industry, driven by the Trump administration and the enactment of the “One Big Beautiful Bill Act.” Providers, insurers, and health IT companies are bracing for Medicaid cuts, major changes to the Affordable Care Act, and reduced funding for providers. As major policy shifts continue to unfold, other legislation introduced by Congress provides insight into the future challenges that stakeholders in healthcare may face.
Lawmakers in both the House and Senate have put forth bills aimed at reforming Medicare Advantage plans, transforming transgender healthcare, integrating artificial intelligence into the sector, regulating certain practices of pharmacy benefit managers, and equalizing payments among various providers. These bills reflect a mix of attempts to counter changes made by the Trump administration, protect access to healthcare services, and further cut government healthcare programs.
One key area of focus is the 340B drug discount program, which has been a subject of debate due to concerns about its expansion beyond its original purpose. Bills introduced this year aim to extend 340B discounts to rural emergency hospitals and shield providers’ use of contract pharmacies to dispense 340B drugs. However, issues around improper dispensing and lack of savings passed along to patients continue to be points of contention.
Legislation addressing pharmacy benefit managers (PBMs) seeks to address anticompetitive practices, enhance transparency, and prohibit practices like spread pricing. Reforming payments to PBMs could potentially result in significant cost savings for the healthcare system.
The future of Medicare is also a focal point, with bills introduced to expand coverage, address the rising costs of Medicare Advantage plans, and improve oversight of insurer practices. Efforts to stabilize Medicare and ensure its sustainability are crucial as more Americans age into the program.
Changes to Medicaid and the Affordable Care Act (ACA) are also on the agenda, with policies in place to cut federal healthcare spending, enact work requirements, and modify ACA enrollment standards. The ACA continues to be a point of contention, with proposals to enhance navigator programs and address issues like unauthorized plan changes.
Legislation addressing violence against healthcare workers, rural hospital funding, site-neutral payments, abortion access, artificial intelligence in healthcare, telehealth, and cybersecurity are also being considered. These bills aim to address critical issues facing the healthcare industry, from workplace safety to access to care and data security.
As lawmakers navigate these complex healthcare challenges, stakeholders in the industry must stay informed and engaged to advocate for policies that promote quality care, affordability, and patient safety. The evolving legislative landscape will shape the future of healthcare delivery and access for years to come.
