Earlier today, Congress passed the One Big Beautiful Bill Act (OBBBA), a set of tax and budget-related policies, including a number that impact our community.
Below are several important takeaways based on our first impressions of select provisions. The following analysis is through our lens as a patient-first advocacy organization, and considers our priorities around health care accessibility, affordability, availability, and adequacy.
Medicaid
The bill is expected to reduce nearly $1 trillion in federal Medicaid spending over 10 years, which nonpartisan estimates say could result in approximately 17 million Americans losing coverage through a number of provisions that change Medicaid and Affordable Care Act (ACA)-related policy – namely reductions in the federal share of spending for people in states that expanded Medicaid coverage as part of the ACA and work eligibility requirements. Most of these provisions are set to go into effect in late 2026.
Taken together, these Medicaid provisions are deeply concerning as they could negatively impact access to care for some of the most vulnerable patients with brain tumors. NBTS is on record, along with many other health care related groups, in opposing the Medicaid cuts in the OBBBA, as it’s critical for patients diagnosed with a brain tumor to be able to access adequate specialized care in a timely way.
For brain tumor patients on Medicaid or impacted ACA Marketplace plans, it will be important to pay attention to new requirements for eligibility and, subsequently, stay on top of them in order to maintain coverage. We’ll communicate more when we know more about work and other eligibility-related requirements. And until these provisions go into effect, NBTS will consider what resources we can provide to potentially help Medicaid-eligible patients with brain tumors understand and complete paperwork requirements.
Rural Health
Because rural hospitals treat fewer patients than centers in more populated areas, any loss of patients is particularly pronounced. With more uninsured patients avoiding care, there’s a concern that rural hospitals could close due to loss of revenue. In an attempt to offset the impact of these Medicaid cutbacks, the OBBBA establishes a $50 billion (over 5 years; $10 billion/year) rural hospital relief fund. However, there is conflicting analysis on the sufficiency of this fund.
We know that most patients diagnosed with brain tumors receive care, at least initially, in the community setting, and not immediately at large academic centers. Thus, access to rural and other community hospitals is quite important given how quickly many patients with brain tumors need care including surgery, scans, and adequate pathology. As such, we’ll be monitoring developments in this space closely.
Orphan Drugs
The bill permits drugs with one or more orphan drug indications (a drug used to treat, prevent, or diagnose a rare disease or condition that affects fewer than 200,000 people in the United States) to be exempt from Medicare Drug Price Negotiations (current law permits exemptions for drugs with only one orphan drug indication). This is a provision that NBTS has supported, as we and other stakeholders contend that expanding this exemption to include rare diseases with multiple indications will encourage more research and development of orphan drugs, which should benefit patients with brain tumors and others.
Taxes
The bill provides for a new charitable deduction for the estimated 90% of taxpayers who do not itemize. Specifically, single taxpayers will be allowed to deduct up to $1,000 and $2,000 for married couples filing jointly for certain charitable contributions – beginning January 1, 2026. This provision is intended to encourage charitable giving by non-itemizers, which should have a positive impact on donors who do not itemize their tax deductions who support NBTS through charitable donations. But, the bill also sets a floor and a cap for charitable donation deductions for itemizers, which could dampen philanthropy by higher income/higher net worth tax payers. The net effect on these reforms on nonprofit charitable giving are still to be determined.
The full impact on brain tumor stakeholders will likely not be known until the legislation is implemented, given conflicting analyses and projections for the effects of the bill. However, we wanted to share a brief, immediate analysis with you, our dedicated advocates.
What OBBBA makes clear is the need to continue to speak up for the needs of this community – in support of policies that could advance our mission and against those that could hinder it. To that end, we remain focused on our Public Policy Agenda and will work with any and all members of Congress who can help move these priorities forward. Visit our Action Alert page today to advocate for policies affecting patients with brain tumors.
As always, we’ll continue to keep you informed of public policy that affects our community and share opportunities for action when necessary and appropriate.
