How Healthcare Leaders Can Turn OBBBA Turbulence into 2026 Momentum

Key takeaways:

• H.R. 1, the "One Big Beautiful Bill Act," is projected to lead to more than $1 trillion in cuts over the next 10 years.
• While every corner of healthcare will feel the pinch, the new law also brings an opportunity to drive long-term resilience and growth.
• This new era calls for an enterprise-wide strategy integrating finance, clinical operations, supply chain and growth.

The healthcare industry hasn’t had a calm year in over a decade. Policy shifts, rising costs and new technologies keep rewriting the rules, forcing health system leaders to react quickly or fall behind.

As the latest disruption, the One Big Beautiful Bill Act (OBBBA), goes into effect, it may feel like there’s no time to breathe. More than $1 trillion in cuts are expected over the next 10 years, and every corner of healthcare will feel the pinch.

But the new law also brings an opportunity to drive long-term resilience and growth.

Siloed responses won’t go the distance. The OBBBA era calls for an enterprise-wide strategy integrating finance, clinical operations, supply chain and growth. This holistic approach enables organizations to overcome OBBBA’s looming hurdles.

By taking these steps, health system leaders have a surprising opportunity to thrive during OBBBA while staying true to healthcare’s North Star: delivering better care at lower costs.

1. Anticipate risks before they arrive.

Any successful strategy starts with a clear-eyed assessment of what lies ahead.

First, consider the financial impact of the looming market disruption. Deep Medicaid cuts, tax credit restrictions, stricter marketplace eligibility requirements and only minimal increases to physician reimbursement will heighten financial risks.

“Even for organizations that are financially stable now, there are extreme risks ahead,” says Amanda Vallozzi, Managing Director and Practice lead for Financial Transformation at Premier.

Health systems should anticipate supporting patients with high deductibles while managing an increase in uncompensated care and shifts in payer mix. These and similar pressures can squeeze margins.

OBBBA’s disruption will also bring clinical challenges.

The number of people without insurance in the U.S. could rise by 14 million due to OBBBA provisions and potential changes to the Affordable Care Act exchanges, which would push the nationwide uninsured rates as high as 15% and even up to 20% in some states.

Service lines with high Medicaid populations, such as those treating older adults and mental health conditions, as well as maternal and pediatric care, are most likely to feel the pressures of more clinical hours per case and heavier administrative burdens.

This may sound daunting. But by understanding what's ahead, organizations can act now to strengthen margins, secure market position and cement resiliency.

2. Prepare for OBBBA's impact.

The next few months offer a window to prepare for OBBBA’s impact on the healthcare market through low-cost, high-impact strategies.

One of the most effective tactics is strengthening relationships with managed care providers and commercial payers. Negotiations are likely to become more challenging as they lose flexibility on pricing. So, look beyond traditional rate discussions and explore different models, including value-based care.

To mitigate clinical pressures, organizations should focus on utilization, acuity and efficiency. Start by going upstream, connecting with patients before they arrive in the emergency department via preventive strategies embedded in daily operations. Then, support the workforce with cross-training and float pools that help them adapt to changing demands.

3. Save margins from the squeeze.

Preparation is only part of the equation. For healthcare leaders accustomed to running on razor-thin margins, now is the time to build lasting financial stability.

Begin by optimizing non-labor cost spending, including eliminating overlapping or underused services. Leadership should also put vendor spend under the microscope to ensure they deliver on quality.

Studying payer strategies within your market is a strong first step to enhancing revenue. Lean on clinical documentation to ensure fair reimbursement. Prioritize patient engagement by investing in virtual care. And when evaluating automation technology, a proven ROI is non-negotiable — the right tools free your workforce to focus on services that need a human touch.

The supply chain is a powerful lever, too. Consider channeling non-clinical spend through your supply chain department to help centralize contracting and decision-making processes. High-commitment performance groups can also be a powerful tool, enabling greater standardization of supply choices and volume discounts that boost savings, product availability and resiliency.

And as margin-minded leaders work to manage financials, remember this insight from Jeff Ashkenase, Managing Director for Supply Chain Optimization at Premier: “Supply chain is a service department. It enables meaningful change.”

4. Lead with a digital-first network.

A key concern for healthcare leaders is that OBBBA will expose underperforming service lines. Two areas in particular — maternal and geriatric care — are especially vulnerable, and disruptions in either could increase clinical load. Meeting these challenges while laying the groundwork for growth begins with asking some hard questions.

First, ask whether a full-service network is best suited to the community’s needs. Consider that a narrowed set of offerings or specialties may drive greater value by establishing core services and freeing resources to go deep in select areas.

Then, ask whether a primary care provider-first model still makes sense for your organization. Increasingly, leaders are looking to a three-tiered design that’s digital and AI first — followed by virtual and then physical locations — to create more sustainability.

“We have to aggressively build our digital AI network, similar to how we aggressively built PCP-first networks over the last 10 years,” says Michelle Moratti, Premier's Managing Director for Strategy and Growth.

That kind of investment is primed to pay dividends. A digital-and-AI network layer can help expand access, support digital triage, flag and track uncompensated care, customize engagement, and guide patients to the right care, in the right place, at the right time.

By leveraging social determinants of health data and advanced technology, health systems can also ease pressure on emergency departments and inpatient settings as patient volumes grow.

How? Triangulating data in new ways — such as combining lab, clinical and financial data — can help identify high-risk cases before they arrive at the hospital. Digital technology can support real-time capacity and dynamic bed management. And emerging tools, such as digital twins and agentic AI, may help anticipate and prevent operational challenges.

By rethinking networks and implementing solutions now, healthcare organizations can set themselves up to deliver care more effectively — staying true to their North Star.

5. Drive growth through quality.

Accelerating growth in the OBBBA era calls for reframing quality from a cost center to a revenue generator. And for good reason.

“We expect around 10 to 12 percent of margins across the board to be linked to quality and equity, either directly or indirectly,” says Dr. Abhi Sharma, Premier's Managing Director for Clinical Transformation.

To support this mind shift, create a B2C — or bedside-to-C-suite — governance strategy on quality. In order to catch and correct any missteps, everyone within the organization must have visibility into quality metrics.

A strong quality strategy also calls for well-staffed chronic care programs — specifically for COPD, cancer, congestive heart failure and diabetes — to meet growing patient volumes. Embedding standardization of care into a technology backbone can help reduce variation and unwarranted care, both of which can degrade quality.

It’s also essential to get to know the community through tools that enable personalized engagement. Digital tools allow for a two-way exchange: Providers understand patients better, and patients better understand their care. In turn, that connection drives better outcomes.

Finally, as providers draw community members into a digital-and-AI network, clearly define and communicate what sets the health system apart from competitors. Patients want to know their chosen providers’ mission and objectives align with their own. Building that connection is imperative to sustaining business, competing effectively and driving quality outcomes.

Follow Healthcare's North Star

As healthcare organizations prepare for OBBBA, they can trust the strategies outlined here to help deliver resiliency and growth. But the deeper value lies in how these approaches support people.

Every effort — from building a digital-and-AI network layer to strengthening payer relationships, implementing workforce-enhancing tools, enriching patient engagement and integrating the supply chain — helps organizations adapt to change while remaining centered on their teams and patients.

Together, these strategies enable leaders to focus on delivering high-quality, low-cost care to their neighbors, no matter what happens in the market.

For more information about how to thrive during OBBBA, visit Premier’s dedicated OBBBA landing page and learn from our experts in our latest webinar.