One MD Leader Shares His Concerns Over the House Budget Bill and Medicaid
As Healthcare Innovation reported on May 22, “In an all-night session that was finally gaveled down just before 7 a.m. on Thursday morning, May 22, the House of Representatives passed a comprehensive FY2026 federal budget bill, with only Republican votes, and all House Democrats voting against it. The bill, H.R. 119, whose official name is the “One Big Beautiful Bill Act,” in deference to President Donald Trump, who had personally lobbied for its passage through the House, involves a massive tax cut for the wealthiest Americans, partly offset by hundreds of billions of dollars in cuts to Medicaid, with the Congressional Budget Office (CBO) estimating that $625 billion in savings would be achieved by effectively removing at least 7.6 million Americans from the program. In addition, the CBO announced late on Tuesday, May 20, that the increase in the national debt of $2.3 trillion over the next 10 years, will trigger as much as $500 billion in Medicare cuts, beginning in 2026.”
But there’s more. An updated analysis from the Washington, D.C.-based Center on Budget and Policy Priorities published on May 23 found that, based on the CBO’s calculations, “Roughly 15 million people by 2034 would lose health coverage and become uninsured because of the Medicaid cuts, the bill’s failure to extend enhanced premium tax credits for Affordable Care Act (ACA) marketplace coverage, and other harmful ACA marketplace changes, according to estimates from the Congressional Budget Office (CBO). This figure could well rise to account for last-minute changes in the House that made the bill harsher. CBO estimates project that 7.6 million people would become uninsured due to Medicaid policies passed by the Energy and Commerce Committee (E&C).” But, the Center on Budget and Policy Priorities notes that, in addition to that basic 7.6-million figure, “1.8 million people would become uninsured due to codification of the Trump Administration marketplace rule provisions, which the E&C Committee also passed.” And “2.1 million people would become uninsured because of marketplace policies passed by the Ways and Means Committee.” Further, “An additional 4.2 million people would lose marketplace coverage because the legislation fails to extend the premium tax credit enhancements.” So, based on those calculations, 15.7 million Americans could lose health insurance coverage, if the bill passed by the House of Representatives were to be passed in the exact same form by the Senate and signed into law by President Donald Trump.
Senior leaders of patient care organizations that disproportionately care for patients covered by Medicaid and/or disproportionately care for marginalized communities, have been responding with concern and even alarm to the passage of the House bill. And though the bill’s passage through the Senate could lead to very major and even fundamental changes, the present threat to the Medicaid program is causing many providers to express deep concern over patients’ potential loss of access to care, as well as the further fragilization of the patient care organizations that take care of them.
One such leader is Imamu Tomlinson, M.D., CEO of the Irving, Texas-based Vituity, a multispecialty national physician partnership involving 6,000 clinicians in 690 care locations that provides care to 12 million patients in 27 states, with its highest concentrations of care locations in Illinois, California, Indiana, Michigan, and Florida. Its clinicians provide patients with emergency medicine, hospitalist care, urgent care, primary care, anesthesia, and neurology. The physician leaders at Vituity are committed to caring for disadvantaged patients, and all physicians practicing in the group are partners. The organization has zero private-equity funding; all physician leaders are required to be practicing clinicians.
Dr. Tomlinson has been CEO for nearly ten years, and continues to practice as an emergency physician. He recently shared his concerns about the federal legislation with Healthcare Innovation Editor-in-Chief Mark Hagland. Below are excerpts from that interview.
Tell me about your concerns around the budget bill that passed through the House of Representatives last week.
There were numerous health system leaders who went to Washington in the past two weeks before the bill’s passage, asking the members to slow down and consider an untoward consequences of Medicaid cuts. And our costs are high on a national level, but when you dig down into the ability to deliver care on the individual level—this is a year in which health systems did better in terms of margins; but many had been operating in negative margins for years. And our motto at Vituity is that we provide the care that patients need.
So we’re reliant on Medicaid: often, Medicaid covers patients who are at risk. And my overriding issue is, I’m not a politician, but I think that everybody should be cognizant of any cuts, per major impacts on access and delivery.
The CBO has revised its estimates upwards, of the number of Americans who could ultimately lose their insurance because of the legislation’s provisions, to 15.7 million, based on what was in the bill as it was passed in the House. What kind of impact do you see?
There could be widespread impact, along multiple dimensions. To begin with, our healthcare system is super-complex. And what is Vituity’s business? It’s that interface between patients and their health. We do the best we can for patients. And there are several laws like EMTALA [the Emergency Medical Treatment and Active Labor Act of 1986] that are consistent with the idea that all people should be taken care of. And anything that makes access harder will be a challenge. And one of the unintended consequences of the No Surprises Act has been delays in payments. And our patients are often socioeconomically challenged patients and households. And we believe our margins will be reduced. And the challenge is that many provider groups are teetering on the edge of financial insolvency. And in suburban America, you have private payers, etc.; but you’ll end up seeing healthcare deserts in urban areas and in some rural areas; hospitals are going to close. Healthcare is the only industry I’ve seen in the past years where we talk about reduction in costs. Look at Amazon, Chipotle; nobody talks about reducing the cost of care for producing new cars. And costs are going up, workforce, materials, costs are going up. So it’s very hard to reduce the cost of care while delivering high-quality care.
If we start seeing healthcare delivery deserts forming, that will disproportionately affect those already marginalized, correct?
Yes, people who are marginalized socioeconomically and in terms of the social determinants of health, will be even more impacted. And I go back to Finance 101 or Business 101 in college: if you look at different systems or niches in business, you typically invest in order to build a great business; you can’t cut your way to thriving in business. And what could have happened was that we as a country could have invested in healthcare infrastructure, in order to make the entire system more efficient. We take care of a lot of ED patients, many of whom are using the ED as their only point of access, and that’s a very expensive way of providing primary care. So the access points will actually increase costs in the healthcare system.
And there’s another part to this: I am an optimist, and I just feel that while a lot of these disruptions will be devastating in the short term, but out of this, people end up being more creative, and I think there are some creative solutions in healthcare. We have an innovation hub, and there are a lot of things we’re doing to make great work even better. Hopefully, the Mark Cubans of the world and others will get together and try to fix things. If the government would listen to us, we could probably satisfy that Quadruple Aim in new, creative ways.
And I would just say that the margins for providers providing and delivering the care are much, much lower than the margins for the pharmaceutical industry and the payers. And how we deal with the payers and how do we make sure we can recruit the best physicians and give them appropriate compensation, needs to be addressed.
