Date of Award
2026
Embargo Period
5-1-2026
Document Type
Dissertation
Degree Name
Doctor of Health Administration
College
College of Health Professions
Abstract
The “Big Beautiful Bill” is expected to affect the financial health of U.S. hospitals. We performed a scenario analysis using five case studies combined with national data on payer mix information to illustrate potential impact in 2027. The scenarios explored the following question: What is the expected healthcare access and economic impact of H.R.1 under three sets of assumptions: 1) loss of Medicaid coverage for 10% or more of an institution’s current patients who will then become uninsured; 2) decrease in Medicaid payments by 10% or more; 3) loss of Medicaid coverage and decrease in Medicaid payments simultaneously. We defined scenarios to capture variations in hospital size, rural/urban location, specialty, teaching and non-teaching classification, and geographic region.
The results indicate that large teaching hospitals may be most resilient to the payment and coverage changes in Medicaid, while small rural hospitals and children’s specialty hospitals are most sensitive. These results may be applied by health systems to inform planning and strategy development.
Recommended Citation
Pruitt, Tangee, "A Scenario Analysis of the Impact of H.R.1 2025 Medicaid Coverage Loss and Payment Reductions on U.S. Hospital Operating Margins" (2026). MUSC Theses and Dissertations. 1126.
https://medica-musc.researchcommons.org/theses/1126
Rights
Copyright is held by the author. All rights reserved.