By Todd Doze, Chief Executive Officer, Janus Health
LinkedIn: Todd Doze
LinkedIn: Janus Health
The healthcare industry has been here before: at the edge of change, watching policy decisions ripple downstream. But few legislative shifts have landed with the weight of the recently enacted “One Big Beautiful Bill.”
Passed into law this July, the bill brings with it $930 billion in Medicaid cuts that are expected to cause nearly 12 million Americans to lose health insurance coverage, tightened Medicaid eligibility rules, and funding reallocations that will significantly alter how care is paid for and who gets covered.
One less-noticed provision of the bill would cut subsidies for those who obtain coverage through the marketplace set up by the Obama-era Affordable Care Act, which will leave several million more people across the nation without a health plan. Today, healthcare accounts for about 8% of total household expenditures for Americans, but that number could rise substantially for many families as a result of the recent cuts.
The policy landscape: A tipping point for hospitals
For many health systems, the bill’s provisions are not merely a budgetary concern. They are a direct threat to health systems’ mission: to serve patients in their communities, especially those already facing barriers to care. In rural and underserved areas, particularly, where hospitals are often the sole source of both urgent and preventive services, financial stability means survival — for the organization and the community it supports.
Just consider: In 2023, 48% of rural hospitals operated at a loss — and that was before the One Big Beautiful Bill’s Medicaid cuts. Medicaid plays a vital role in delivering health to rural Americans, with 47% of rural births in the U.S. and 65% of nursing home residents in rural counties covered by Medicaid, according to the American Hospital Association.
Health system leaders now face a stark reality — more patients with unstable coverage, higher uncompensated care risk, and fewer federal dollars to absorb the difference. And while national policy may be out of their hands, one powerful truth remains: Health system leaders can’t control policy, but they can control performance.
For health systems, the implications are clear:
- A deteriorating payer mix
- Increased uncompensated care
- Rising financial pressure
- More friction in the front-end and back-end of the revenue cycle
Elements of the bill are also likely to negatively impact hospitals’ operations and staff productivity. For example, as a result of Medicaid cuts, patients are likely to delay care until emergency situations arise, increasing uncompensated ER visits and ratcheting up financial pressure on hospitals.
In general, rising uninsured patient volume will eat into hospital resources, leading to more uncompensated care and even narrower margins. As margins narrow and finances tighten, hospitals will have little choice beyond resorting to layoffs, reduced hiring, or hiring freezes. Remaining staff will then be forced to deal with heavier workloads, boosting burnout and decreasing productivity – prompting many to seek employment in other industries with greater stability.
The ripple effects will vary by region, but rural and safety-net hospitals are likely to feel the greatest strain. These systems already operate on thin margins, and without operational excellence, they risk falling into deeper financial jeopardy. For them, revenue cycle management isn’t just an internal function — it’s the front line of protecting access.
What health system leaders can do right now
In times of disruption, strong operators do not wait, they act. What’s needed now is not panic or paralysis, but precision and focus.
The path forward demands:
- Streamlined access workflows
- Reduced administrative waste
- Faster reimbursement
- Optimized workforce productivity
- Proactive denial prevention and resolution
- Investment in technology
A high-functioning revenue cycle is no longer a back-office metric. It’s a strategic imperative. When systems are paid accurately and quickly, they can reinvest in care delivery, keep clinics open, staff full, and services within reach — especially in the places where they’re needed most.
How automation helps health systems stay ahead
Leading health systems are looking to modernized RCM solutions that enable them to do more with less: automating what’s manual, surfacing what’s hidden, and empowering teams to move faster, smarter. These platforms help hospitals:
Get it right the first time:
- Automating prior authorizations, referrals, and Notice of Admission
- Reducing delays and front-end errors that lead to downstream denials
Know exactly where claims stand and why:
- Delivering real-time claim status intelligence
- Reducing rework and streamlines access to the most critical claims needing attention
Put the right work in the right hands, automatically:
- Surfacing payer-specific friction points, individual and enterprise level performance insights with AI-powered agents
- Helping reduce burnout and increase throughput without additional headcount
Ultimately, this creates operational intelligence that drives action, enabling health system leaders to understand where bottlenecks are, uncover behavioral trends by payer and team, and make strategic decisions with real insight — not guesswork.
From policy shock to performance strategy
Yes, this law reshapes health systems’ funding models. But it doesn’t have to upend their future plans. The health systems that will endure will be those that master what they can influence: speed, accuracy, efficiency, and accountability.
And perhaps most importantly, discipline in revenue cycle operations enables these organizations to keep doing what matters most — delivering care close to home, keeping doors open in rural counties, and serving the people who would otherwise be left behind in the policy fallout.
When everything feels uncertain, discipline wins. And revenue cycle discipline is the engine that keeps hospitals running, even in turbulent times. As health systems face the new realities of the “One Big Beautiful Bill,” operational focus will determine which organizations survive and thrive.