Message from the ASA President

July 11, 2025

We are now in a post “One Big Beautiful Bill” era and as physicians it is a time of uncertainty. The enactment of this historic bill is projected to bring significant changes to the health care landscape, including changes that could directly affect our profession and our practices.

The "One Big Beautiful Bill," also known as H.R. 1, had, for months, been a singular legislative priority for President Trump and congressional Republicans. At the White House bill signing ceremony on July 4, the President lauded the legislation in which long-standing presidential and Republican priorities were achieved, including reducing federal government spending, making permanent existing tax policies enacted during the first Trump Administration, increasing funding for national defense, and boosting resources for U.S. border security.

In the months of debate leading up to enactment, we worked on our own and in a number of large coalitions to address priority concerns of our members, namely Medicare physician pay, changes to Medicaid, and modifications to federal student loan programs. Together with other stakeholders, we won some modest changes, but our concerns remain. We continue to be particularly concerned about projections of significant increases in the uninsured and the resulting uncompensated care. The same projections raise distressing questions about the economic viability of many of our hospitals, especially those in rural areas.

While the enactment of the law marks the completion of the congressional debate—a contentious and heavily partisan debate—it also marks the next phase in ASA’s advocacy. Our work will continue. Constructive changes to H.R. 1 are necessary for our patients, our practices and profession, and our health care system.

Our physician and staff leaders have begun to address the feasibility of working with other key stakeholders to mitigate the impact of the law. We have initiated outreach to others in medicine and health care, including the American Hospital Association, to begin discussions on next steps. Many of the key provisions of the law do not take effect until after the 2026 elections, so there will be opportunities for improvements prior to implementation and before the impact of the law will be felt.

As we advance our advocacy work, we remain committed to keeping you informed of developments that impact you and our profession. We thank you for your engaged support, and your comments and questions. I welcome your feedback at [email protected].

For our ASA,
Donald E. Arnold, MD, FACHE, FASA
President