Medical practice administrators are facing a wave of potential policy changes as the sweeping One Big Beautiful Bill Act is implemented, according to Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA). Speaking in an interview, Gilberg said the legislation and related regulatory moves could reshape payment, coverage, and compliance issues in the years ahead.
Medicaid cuts loom, but implementation uncertain
The bill includes provisions that the Congressional Budget Office predicts could push 10 million Americans off Medicaid beginning in 2027 or 2028. The changes are tied to new administrative requirements, such as work reporting.
“Even if people are working, if they don’t report it at the right frequency, they lose their coverage,” Gilberg said. “That’s what CBO is looking at.”
He cautioned practices against making hasty business decisions, such as closing sites, based on future Medicaid changes that could still be revised or repealed. “Stay tuned. See what happens,” he said, noting that state policies will also play a major role.
Medicare payment adjustments leave gaps
For 2026, Congress authorized a 2.5% increase in physician Medicare reimbursement. But practices will still face a 2.83% cut in 2025 that was left unresolved.
“Even with the increase, we aren’t where we were last year,” Gilberg said. “It really speaks to the fact that we need a permanent solution.”
CMS also announced adjustments to relative value units (RVUs) in the Medicare Physician Fee Schedule. While primary care could see modest gains, surgical and specialty practices may face unexpected cuts.
“They just instituted an across-the-board cut on thousands of codes,” Gilberg said. “The methodology doesn’t really make sense, and the last thing we want is arbitrary government decisions on physician payment.”
What practice leaders need to know now
- Medicaid cuts
Possible work-reporting rules could drop 10 million patients by 2027–28, but changes aren’t final. Don’t overreact yet. - Medicare reimbursement
+2.5% bump in 2026, but a –2.83% cut still hits in 2025. RVU shifts may help primary care, hurt specialties. - Prior authorization
Insurer “pledges” won’t solve delays. MGMA says legislation is still needed, especially for Medicare Advantage. - ACA subsidies
Expire at end of 2025 unless Congress acts. Premiums could double; expect more uninsured visits. - Telehealth
COVID-era flexibilities end in September without renewal. MGMA is pushing for a two-year extension. - Rural practices
The “GPCI floor” expires in September. Without it, rural physicians risk lower Medicare pay.
Takeaways:
✔ Verify patient eligibility upfront
✔ Budget cautiously for reimbursement shifts
✔ Stay active with advocacy groups
✔ Watch Congress closely this fall
Prior authorization reform remains priority
With Medicare Advantage now covering more than half of all beneficiaries, MGMA continues to press for legislative fixes to prior authorization requirements.
Gilberg dismissed insurers’ voluntary pledges to improve the process. “Many of the things they pledged to do, they’re already required to do by law,” he said. “We’ve seen such massive abuses over the last couple of years that we still need a legislative approach.”
Coverage subsidies and eligibility checks
Another looming issue is the expiration of Affordable Care Act subsidies at the end of this year, which could sharply raise premiums for millions of patients. Administrators should be vigilant with eligibility verification and revenue cycle management to avoid financial surprises, Gilberg warned.
“You don’t want patients coming in who think they’re covered, but suddenly they’re uninsured,” he said. “Then you have to make tough decisions about cash payments, and a lot of that money ends up uncollected.”
Telehealth, rural pay parity at risk in September
Congress faces several deadlines at the end of September, including decisions on telehealth flexibilities and rural payment parity.
Without action, telehealth coverage rules that have allowed patients to access care from home since COVID-19 could expire. Gilberg said MGMA is backing at least a two-year extension.
Rural practices are also watching the potential expiration of the “GPCI floor,” which ensures Medicare payment parity with urban areas. “Without renewal, rural physicians could be disadvantaged,” he said.
Technology and data politics raise questions
Gilberg said MGMA members remain wary of the federal government dictating technology use but acknowledged that uniform standards are needed to reduce inefficiencies and improve interoperability.
He also flagged concerns about political interference with federal economic data, which feed into Medicare payment formulas. “Even though it’s indirect, making sure inflation numbers are accurate is critical,” he said.
Preparing for an active fall
With so many deadlines converging, Gilberg urged practice leaders to stay engaged with advocacy groups and monitor developments closely. MGMA will provide updates at its leadership conference this fall in Orlando.
“The concept is bringing leaders together to solve problems,” he said. “We want to make sure practices can improve revenue, cut costs, maintain a healthy workforce, and reduce burnout.”
