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Understanding the One Big Beautiful Bill (OB3) and Its Impact on Oncology

Published Date: August 21, 2025

Author: NCODA Partner Development Team

On July 4, 2025, President Trump signed into law the One Big Beautiful Bill Act (OB3)—a nearly 900-page package that reshapes federal tax, healthcare, and entitlement programs. While positioned publicly as a broad tax relief and domestic policy agenda, OB3 contains provisions with significant implications for oncology providers, patients, and the life sciences community. 

To help partners navigate this complex legislation, NCODA hosted a webinar with Joel White of Monument Advocacy, who broke down the bill’s healthcare provisions and their potential ripple effects across the oncology ecosystem. 

Key Healthcare Changes in OB3 

  • Medicare Adjustments 
    • A one-time 2.5% payment update for providers in 2026—short of the long-term inflationary updates practices were hoping for. 
    • Future payment stability remains uncertain, making advocacy on sustainable reimbursement a continued priority. 
  • Orphan Drug Act Revisions 
    • Drugs will now be shielded from price controls until after approval for a second indication, rather than after the first. 
    • This is particularly important for oncology, where ~60% of therapies originate from secondary indications. 
  • Affordable Care Act (ACA) and Coverage Shifts 
    • Stricter income verification rules for ACA premium subsidies may result in up to 3.6 million individuals losing coverage by 2034. 
    • Expanded Health Savings Accounts (HSAs) aim to soften the blow for patients with high deductibles. 
  • Medicaid Reform 
    • New eligibility restrictions (including for undocumented individuals). 
    • Work/community engagement requirement: 80 hours per month for able-bodied adults. 
    • Funding changes that cap state-directed payments and limit provider taxes. 
    • These shifts are projected to remove ~10 million individuals from Medicaid/ACA coverage by 2034. 
  • Rural Health Transformation 
    • A new $50 billion stabilization fund aims to support rural hospitals and providers, though distribution criteria will vary by state. 

What This Means for Oncology Practices
The oncology community may soon see: 

  • Increased financial strain as more patients lose insurance coverage, leading to higher patient cost-sharing struggles. 
  • Drug development incentives shifting, with orphan drug provisions giving oncology research more breathing room before facing price controls. 
  • Greater reliance on advocacy, as long-term stability in Medicare physician reimbursement remains unresolved. 

In the webinar, Joel White encouraged providers to prepare for increases in bad debt and to actively engage lawmakers with real-world stories of patient and practice burden. 

While OB3 delivered on the administration’s top priorities, several important issues remain on the table: 

  • PBM reform has bipartisan momentum and could advance by year’s end. 
  • Regulatory moves are expected to address drug pricing and expand healthcare data transparency, with AI highlighted as a tool to reduce administrative burden 

 Next Steps for NCODA Partners 

  1. Stay Informed: NCODA will continue providing updates as OB3 provisions are implemented and as subsequent reforms (like PBM legislation) unfold. 
  2. Engage in Advocacy: Partners are encouraged to share how coverage losses, Medicaid changes, and payment instability affect both patients and providers in oncology. These voices are critical for shaping practical policy solutions. 
  3. Plan for Operational Impact: As oncology practices prepare strategies to manage increased patient financial distress, including enhanced financial counseling and pathways to patient assistance, partners can look for ways to support practices through these transitions 

To discuss these changes or ways to partner with NCODA please reach out to a member of the Partner Development team!