President Donald Trump’s One Big Beautiful Bill Act, which includes Medicaid cuts, rural healthcare system investments and a temporary 2.5% Medicare Physician Fee Schedule boost for some cases, was signed July 4.
Spine surgeons discuss how they foresee the bill’s effect on their work.
Note: These responses were lightly edited for clarity.
Question: How will President Trump’s spending bill affect spine care in the short and long term?
Chester Donnally, MD. Texas Spine Consultants (Addison): This current spending bill is about restoring efficiency and sustainability to the health care system — something that should ultimately help spine surgeons. It is always a good thing to trim bureaucratic waste and shift focus on value-based care and innovation. It also includes rural stabilization funding, which, when combined with deregulation, may allow smaller hospitals to retain high-demand specialists and invest in targeted surgical lines instead of being spread thin. For spine surgeons, this means more flexibility to practice advanced medicine in streamlined, supportive settings — and more long-term stability in how care is delivered and reimbursed.
Thomas Errico, MD. Nicklaus Children’s Hospital (Miami): We are a polarized country right now. If you are a die-hard Trump supporter, you are thrilled with the bill. If you hate Trump, this bill will destroy the country. The truth is usually to be found in the middle.
For lovers, the bill will have significant tax cuts for middle- and working-class families. amounting to as much as $10,000 annually in all important increased take-home money. Increased tax deductions for State and Local Taxes (SALT) helps others. Good!
For haters, I have seen estimates of health care stripped from 17 million Americans. Bad! Closer inspections suggest CBO estimates of potentially 12 million newly uninsured by 2034. Bad, but the timing gives hope that local, state and revisited Federal policies can mitigate the downside in some way.
There is a provision for tightening verification requirements for the Affordable Care Act subsidies. This could result in lost coverage for some. For Medicaid Enrollees, the bill allows states to impose higher cost-sharing for non-emergency visits, including hospital care. Some Medicaid patients will not be able to afford this, which will lead to higher receivables for the hospital although some may be able to afford the co-payment, which potentially represents more income for the hospital.
Spine Care in general depends on private insurance, government payers, and out of pocket expenditures. Losing insurance coverage is a critical factor and hard to overcome. Increased personal income through tax savings or enhanced overall economy is beneficial to spine care providers.
In summary, there are some potential good effects and some potential bad effects. The bill is brand new and 900 pages long. The impact will demand hospitals and providers to adapt to the effects of the bill’s economic factors. This is my initial interpretation of only some of the salient points. As usual, time will tell.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I think the passage of the bill heralds a large disconnect between perception and reality. Whereas the authoring party of the bill describes the lazy, unmotivated 35-year-old playing video games in their mother’s basement, the reality is different. Most aid recipients work (over 60%) and many are parents with families of their own. This harkens back to the purported immigrants eating dogs fantasy prior to the last election. Patients may find themselves with no insurance due to the scramble to enforce the parameters of the bill. This will result in the old days with patients coming in with zero insurance, and doctors getting stuck with giving out free care. Due to the fear of large hospital bills, this will drive patients to not seek care until things have reached crisis level. All in all, this will undoubtedly decrease care and drive up costs, likely pushing us to single payer.
Alok Sharan, MD. Spine and Performance Institute (Edison, N.J.): President Trump’s spending bill will be a disruptor to healthcare. Medicaid funding to hospitals will decrease, forcing many hospitals to rethink their business models. In addition, research funding to academic medical centers will decrease, adding in another layer of complexity. There will be a tremendous amount of downstream challenges that this will present to both short and long term spine care.
One major challenge that will occur is access to care. Wait times to see a provider will increase. For patients suffering from acute sciatica it will take them longer to get diagnosed and treated. This will result in increased costs as problems that could be taken care of with a low cost high quality visit will turn into a prolonged problem. For example a patient with acute sciatica may benefit from a Medrol Dose pack given by an outpatient provider. Instead, left untreated, the sciatica will perhaps require an epidural injection.
Alternatively the prolonged wait times to see an outpatient provider may result in more patients using the emergency room instead. As it is many ERs are at or near capacity. The problems of access can strain the system further.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The legislation is ostensibly meant to reduce waste, fraud and corporate welfare in Medicaid, in the Obamacare exchanges, while realigning certain work/community programs for able bodied adults. Ultimately, this legislation will be maintaining coverage for the vulnerable and the poor. Certain necessary Covid and Obamacare subsidies were also eliminated to health insurers, which may affect procedural and hospital reimbursements. The most tenuous provision left out of the senates’ draft was the misuse of taxpayer dollars to unauthorized individuals, which clearly is substantive and will resurface in the future.
For those complex spinal surgeons working under an employed model, who administer to the underinsured and vulnerable community, the scrutiny of elective procedures may be additionally reviewed and further discussed in the approval process.
