Healthcare’s Crossroads: New Federal Reforms Set to Reshape Access and Costs for Southeast Texans

Published 3:56 pm Friday, August 1, 2025

Reno Derosier

Territory Manager

National Write Your Congressman

The national debate over healthcare has intensified, culminating in recent federal legislation that is poised to significantly alter how Americans access medical care and manage related costs. For those of us in Southeast Texas, these changes could have a profound impact on household budgets, employment, and the overall health of our community.

Here is a look at the major healthcare reform agendas currently shaping policy in Washington, their key provisions and projected effects on everyday citizens.

The Republican Approach: Less Federal Spending, More Individual Responsibility

A pivotal development is the enactment of the “One Big Beautiful Bill Act” (OBBBA), H.R. 1, signed into law by President Trump on July 4, 2025. This legislation reflects a strategy to reduce federal spending on social programs and introduce more market-driven healthcare solutions.

Key aspects of the OBBBA and its potential impacts include:

• Medicaid Program Changes: The OBBBA is projected to reduce federal Medicaid spending by over $700 billion nationally over the next decade. A significant change involves new work and community engagement requirements for many able-bodied adults aged 18 to 64. To maintain Medicaid eligibility, these individuals would need to demonstrate at least 80 hours per month of work, community service, or educational participation.While proponents argue these measures promote self-sufficiency and program integrity, analyses from various organizations project that millions of Americans, potentially between 10.9 million and 16.0 million, could lose their health insurance coverage as a result.

• The bill also introduces more frequent eligibility redeterminations for Medicaid recipients, requiring states to verify eligibility every six months instead of annually.

• Additionally, it mandates new out-of-pocket cost-sharing requirements for some Medicaid expansion adults, potentially up to $35 per service, though capped at 5% of family income.

• Texas already has the highest uninsured rate in the U.S. and has not expanded its Medicaid program. These federal changes could disproportionately affect low-income families and individuals in our region, potentially leading to more people without health insurance.

• Affordable Care Act (ACA) Marketplace Adjustments: The OBBBA does not extend the Enhanced Premium Tax Credits (PTCs), which are set to expire at the end of

2025. These credits currently help over 22 million people afford health insurance through the ACA Marketplace. Their expiration is projected to result in millions becoming uninsured or facing significantly higher premiums. For example, a typical family of four earning $65,000 could see their annual premiums increase by $2,400.

• The legislation also shortens the annual open enrollment period for individual market coverage and eliminates automatic re-enrollment, requiring individuals to actively re-

enroll each year,

• Broader Economic and Healthcare System Effects: The projected financial strain on hospitals and clinics due to Medicaid reductions could lead to reduced services, staff cuts, or even closures, particularly in rural and underserved areas like parts of Southeast Texas. This could result in longer wait times and increased reliance on emergency rooms for routine care, affecting all community members.

○ Nationally, the combined impact of Medicaid and Supplemental Nutrition Assistance Program (SNAP) reductions could lead to a loss of 1.2 million to 1.3 million jobs and a $154 billion decline in state economies. This could translate to reduced consumer spending locally, affecting businesses and employment across various sectors.

The Democratic Vision: Expanding Access and Lowering Costs

In contrast to the Republican agenda, the Democratic approach, largely articulated through the Biden Administration’s budget proposals, focuses on expanding access to healthcare, enhancing affordability, and strengthening existing public health programs. While the OBBBA is now law, these proposals represent an alternative vision that could offer significant relief if pursued in future legislative cycles:

• Strengthening Medicare and Lowering Drug Costs: Democratic proposals aim to extend the solvency of Medicare by increasing taxes on high-income individuals. They also seek to allow Medicare to negotiate lower prescription drug prices for a broader range of medications sooner, and to cap out-of-pocket costs for certain generic drugs in Medicare Part D. These measures are intended to reduce healthcare costs for seniors and all Americans.

• Enhancing ACA Affordability: A key Democratic priority is the permanent extension of enhanced ACA premium tax credits. These credits have been instrumental in  making ACA coverage more affordable, reducing premiums by an average of $800 per person per year.

• Closing the Medicaid Coverage Gap: The Biden Administration’s budget proposes a $200 billion investment to permanently extend coverage to low-income individuals in

states that have not expanded Medicaid, including Texas. This initiative is projected to provide health insurance coverage to over 2.1 million uninsured adults nationally.

• Continuous Coverage for Children: Proposals also seek to extend continuous eligibility for children in Medicaid and the Children’s Health Insurance Program (CHIP)

from birth until age six, and for 36 months for older children. This aims to ensure uninterrupted healthcare access during critical developmental stages.

Southeast Texas: At the Forefront of Change

Our region, with its significant industrial base and a notable portion of its workforce in lower- wage occupations, is particularly sensitive to these national healthcare policy shifts. As these federal policies continue to evolve, understanding their direct and indirect impacts on our community remains crucial for every resident. Staying informed and engaged in the ongoing  dialogue about healthcare reform will be key to navigating the future of health and well-being in Southeast Texas.