Concerning Budget Bill Advances in U.S. House; Action Moves to Senate

Update: July 3, 2025

The House has approved the Senate-passed bill and forwarded it to the President for his signature into law, which is expected on Friday, July 4.

While we are deeply disappointed in the outcome, we’re grateful to ASHA Advocates who joined us in advocacy. Your efforts, including sending over 32,000 messages to lawmakers, made a powerful statement by helping to raise awareness of programs and services that millions of Americans rely on. ASHA will be sharing a detailed analysis of the law and ways to learn more about how this could impact audiologists and SLPs, and those you serve, in the coming days.

Update: July 1, 2025

The Senate narrowly passed H.R. 1 by a vote of 51-50 with Vice President Vance casting the tie-breaking vote. The bill now heads to the House, which either needs to pass the Senate bill, or amend it and send it back to the Senate for final approval, before it can be enacted into law.

There’s still time for you to share your opposition to this bill with your member of Congress. But you need to act now because the House could vote on this bill as soon as Wednesday. Take action TODAY and tell your representative to protect Medicaid by opposing this legislation.

Update: June 30, 2025

The Senate could vote as soon as today on its version of H.R. 1, the One Big Beautiful Bill Act. Proposed changes would impose deeper Medicaid cuts and unworkable program changes that will further restrict access to needed services, including those provided by audiologists and speech-language pathologists (SLPs). Although the Senate version of the bill includes some positive provisions, such as a one-year 2.5% Medicare payment update in 2026, the negative impact of Medicaid cuts and other proposed language that will reduce access to health care for vulnerable populations will likely far outweigh its potential benefit.

Act TODAY to let your senators know they should keep their promise not to jeopardize health care for millions of their constituents by cutting Medicaid.

June 9, 2025

The U.S. House of Representatives recently passed H.R. 1, the “One Big Beautiful Bill Act” (OBBBA), which reduces funding for and makes significant changes to many federal programs to pay for the Administration’s domestic policy priorities. The bill includes several provisions that ASHA strongly opposes and has worked to remove or revise because they would hurt audiologists’ and SLPs’ ability to serve their patients, clients, and students.

The Senate will soon decide whether and/or what changes to make to the bill before floor consideration. Your action is needed to urge senators to amend this legislation before it’s too late.

Take Action

What Do You Need to Know About the Bill?

Though the bill contains a wide variety of provisions, the following provisions may be of particular interest and impact to audiologists and SLPs:

• Medicaid
• Medicare
• Affordable Care Act
• Education

Medicaid

Work Requirements

Starting on December 31, 2026, states would be required to verify that adults between the ages of 19 and 64 are working for at least 80 hours per month or participating in other qualifying activities as a condition of receiving Medicaid coverage.
Populations that states must exempt from Medicaid work requirements include but are not limited to parents or caregivers of a dependent child or disabled individual; medically frail individuals; pregnant individuals or those receiving postpartum coverage; disabled veterans; Medicare beneficiaries dually eligible for Medicaid; and those participating in addiction treatment programs. ASHA opposes work requirements as they create an unnecessary barrier to care and are difficult for Medicaid programs to manage.

Eligibility/Enrollment

The bill also...

• Reduces retroactive coverage from 90 days to one month prior to the date of application for Medicaid
• Significantly delays regulations that help reduce barriers for dually eligible Medicaid and Medicare beneficiaries receiving assistance with premiums and cost-sharing
• Requires states to implement more stringent practices for updating beneficiary contact information.

Delays and reduced coverage periods create more out-of-pocket expenses for people who need audiology and speech-language pathology services—and individuals who can’t afford the services will likely be forced to go without them.

Redeterminations

Starting on December 31, 2026, states would be required to conduct Medicaid eligibility redeterminations at least every six months for adults. This is administratively challenging for states and overly burdensome for beneficiaries and providers alike.

Cost-sharing for Expansion Populations

The bill establishes mandatory cost-sharing for expansion enrollees who earn over 100% of the Federal Poverty Line ($15,650 yearly income for an individual) up to $35 per service. Cost-sharing, including co-pays, can significantly discourage individuals, particularly those with low incomes, from seeking necessary care.

State Provider Taxes

The bill prohibits states from establishing any new provider taxes or from increasing the rates of existing taxes. All states except Alaska use some form of provider tax to help finance the non-federal share of Medicaid spending. These taxes are most often levied upon institutional providers including nursing facilities, hospitals, and some health plans. This provision is effective upon enactment of the law, but states may have three fiscal years to transition existing provider tax arrangements that are no longer permissible. These provisions would make it more difficult for states to fund their portion of the Medicaid matching rate and could cause states to cut coverage and benefits in order to lower costs.

Gender-Affirming Care

The bill prohibits federal matching funds for “gender transition procedures”—which are defined to include puberty blockers, hormone treatment, and surgery—for all Medicaid and CHIP enrollees. This could impact audiologists’ and SLPs’ ability to provide gender-affirming care to Medicaid beneficiaries.

Learn more about Medicaid:

• Visit ASHA’s Take Action for Medicaid update page.
• Watch Potential Medicaid Funding Changes Ahead: What Audiologists and SLPs Need to Know, an ASHA-hosted webinar that explores Medicaid funding issues in 2025 issues prior to House passage of the bill.
• Explore the differences between Medicare and Medicaid.

Medicare

Payments

The bill links the annual Medicare Part B physician reimbursement update to inflation as measured by the Medicare Economic Index (MEI), which ASHA has advocated for. The provision would make the 2026 reimbursement update 75% of MEI and would make reimbursement updates in subsequent years 10% of MEI annually. While this provision is positive, ASHA and others will need to continue advocating to develop a long-term, sustainable solution to stabilize payments and properly reimburse audiologists and SLPs for the value they bring to Medicare beneficiaries. Learn more about ASHA's advocacy for increased Medicare reimbursement and take action for better Medicare payments.

Telehealth

The bill does not include a provision to extend audiologists’ and SLPs’ ability to provide telehealth services to Medicare beneficiaries. This vital authority will expire on September 30, 2025, unless Congress acts before that deadline. Learn more about ASHA’s advocacy for Medicare telehealth authority and take action for permanent Medicare telehealth authority.

PAYGO

The bill does not address the potential impact of budget rules (called pay-as-you-go or PAYGO) that require new legislation increasing the federal deficit to be offset by reduced spending elsewhere. Medicare payments are subject to this policy, which could reduce payments by as much as 4%. Though Congress routinely waives its application to Medicare payments, ASHA is still concerned about the potential impact. Learn more about federal budget rules impacting Medicare payments.

Sequestration

The bill does not address the ongoing impacts of budget sequestration, which aims to impose fiscal restraint on federal spending through automatic reductions of as much as 2% to federal programs, including Medicare. Learn more about the impacts of sequestration on Medicare payments.

Affordable Care Act (ACA)

Open Enrollment/Special Enrollment

Beginning January 1, 2026, the bill would end the ACA open enrollment period one month earlier and eliminate the year-round special enrollment period for people with incomes up to 150% of the federal poverty level. It also would require enrollees to prove eligibility prior to obtaining coverage. These provisions create unnecessary barriers to care for individuals requiring timely access to audiology and speech-language pathology services. Delaying care can have a lasting negative impact on health outcomes.

Cost-Sharing Reductions

Beginning on January 1, 2026, return to funding cost-sharing reductions—which provide financial assistance for premiums, copayments, and coinsurance for individuals with incomes between 100 and 250 percent of the federal poverty level—through payments from the federal government, with explicit congressional appropriation of funds.

Auto Renewal

Effective January 1, 2026, the bill would discontinue the practice of automatically re-enrolling individuals eligible for cost-sharing reductions. This requires enrollees with a $0 premium (after tax credits) who are automatically re-enrolled in ACA coverage to proactively verify their ongoing eligibility or face a $5 monthly charge until they actively confirm their eligibility. A lapse in coverage due to missing the verification deadline could cause issues for providers seeking reimbursement, and hinder patient access to care.

Gender-Affirming Care

Effective January 1, 2027, the ACA would be amended to prohibit “coverage of gender transition procedures”—including puberty blockers, hormone treatment, and surgery—as essential health benefits. This could impact audiologists’ and SLPs’ ability to continue providing gender-affirming care to beneficiaries.

Education

529 Savings Plans

The bill includes the ASHA-supported Freedom to Invest in Tomorrow’s Workforce Act, which would expand eligible uses of 529 savings plans to include postsecondary training and credentialing, including government-issued professional licenses. Learn more about the Tomorrow’s Workforce Coalition, of which ASHA is a member, and how this provision could benefit audiologists and SLPs.

Student Loan Borrowing

The bill eliminates subsidized student loans for lower-income students and Grad PLUS loans for graduate and professional students. It also scales back Parent PLUS loans by imposing new limits on annual and lifetime borrowing. The bill sets new limits on loans: $50,000 for undergraduates, $100,000 for first time graduate students, and $150,000 for professional or graduate students in second or other programs. It imposes a lifetime maximum borrowing limit of $200,000. It also institutes a new cost of attendance calculation (used in calculating annual loan limits) that would be the “median cost of college of the program of study” across all institutions nationwide offering such a program. Putting financial strain on students (and potential students) blocks access to higher education opportunities, which can impact the future availability of audiologists and SLPs.

Student Loan Repayment

The bill eliminates existing income-driven repayment plans—including Pay As You Earn (PAYE), Revised Pay As You Earn (REPAYE), and Saving on a Valuable Education (SAVE)—and moves existing borrowers to a modified income-based repayment plan. New borrowers will have the choice of two repayment plans: a standard plan with a duration of repayment proportionate to the amount borrowed, and a single “Repayment Assistance Plan” (RAP) that bases monthly payments on the amount the student earns. The bill does not make significant changes to the Public Service Loan Forgiveness program.

Pell Grants

The bill provides funds to address the projected Pell Grant shortfall beginning in fiscal year 2026. It changes the definition of full-time enrollment for Pell Grant eligibility to 15 credit hours, up from the current 12 credit hours, and eliminates federal Pell Grant eligibility for any student enrolled less than half time. It also lowers the cap on Pell Grant eligibility for middle-income students and families compared to current law. Eliminating the ability to enroll part time hurts access to higher education for individuals who are unable to attend school full time.

What’s Next?

The Senate will soon decide whether and/or what changes to make to the bill before floor consideration. ASHA is continuing to pressure lawmakers to improve some provisions and remove others that would hurt audiologists, SLPs, and those you serve.

What Can You Do?

The most important action you can take right now is to share your concerns about this legislation with your U.S. senators. You can do that quickly and easily by visiting our Take Action campaign. Then let federal@asha.org know whether and/or what response you get, which will help inform engagement with those offices. You can also share this Take Action opportunity with your colleagues, friends, and family to encourage them to echo your message.

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Questions?

Contact Jerry White, ASHA's senior director of federal and political affairs, at federal@asha.org.