As many readers know, the U.S. Congress recently passed and forwarded a large legislative bill to the president which he signed on July 4, 2025. The One Big Beautiful Bill Act is close to 1000 pages long and a relatively complex item of legislation. It has many parts and covers many issues important to the current administration. As OMRUM focuses on healthcare in the United States, the legislation will be reviewed from that perspective.
First, it is safe to say what it does not do for healthcare in the US. It does not address the fundamental issues which propel the cost and complexity of healthcare ever upwards. In the July 1, 2025 OMRUM article, The Fallacy of a Dynamic Free Market System for Healthcare, the need for universal healthcare was reviewed as a replacement for our current system which leaves tens of millions of Americans, especially those of modest financial means, entirely uncovered and many additional millions of Americans overwhelmed by medication prices, co-pays, deductibles, and withholds. Additionally, it does not seem to address the double-digit increases which the commercial carriers are petitioning for ongoing coverage in the coming year (2026).
However, analysis of the legislation by the Congressional Budget Office (CBO), a nonpartisan entity within the Congress, predicts a substantial dismissal from medical insurance coverage as a result of the bill. 1 of a number of articles reviewing this comes from CNN Politics on 7/21/25, “10,000,000 more people will be uninsured because of Trump’s mega-package, CBO forecasts” by Tami Luhby. However, a more detailed analysis reveals that Medicaid cuts would lead to 7,800,000 additional uninsured while 4,000,000 more would be uninsured from ACA marketplace cuts. On top of this but not explicitly discussed would be the failure to extend enhanced premium tax cuts for an additional 4,200,000 citizens. This arithmetic suggests that shortly an additional 16,000,000 Americans will lose their healthcare insurance.
At the beginning of the year 2025, the CDC reports that 27,200,000 Americans were without any form of health insurance. It may be simplistic to add the additional 16,000,000 figure of expected losses under the new legislation but if we do, approximately 43,000,000 Americans will be without any form of health insurance in the upcoming future. If we temporarily put aside the moral dimensions of this tsunami of uninsured citizens, can we expect at the very least some massive savings to American society?
The answer, as one might expect, is a resounding no! The next question becomes “why not”?
Once again, to answer this we must cover material reviewed previously in this magazine. By canceling someone’s health insurance, that person is not suddenly without health needs. Since the patient population most affected by these cancellations often has the most modest financial means, their needs will be higher than average but their ability to engage the healthcare system and pay for services will be all but nil without insurance. These patients will no longer present for preventative screenings and will not see a physician for many acute needs, e.g. colds, flus, lacerations, sore throats, simple fractures, and many, many more items. They will simply suffer through. However, when an illness is characterized by extreme suffering such as severe chest pain or pressure, inability to breathe, 10/10 pain of any type, intractable nausea and vomiting, and the like, a patient will engage the medical system not at the most cost-effective end of the spectrum, e.g. primary care, but rather the least cost-effective end of the spectrum, the emergency room.
Allow your author to put this another way-in this illogical and grossly dystopian policy of denying people health insurance, the only way one can actually save money is to deny these same people access to expensive emergency care. This is true in a number of countries, e.g. India. One may have excruciating pain from, for example, dissecting aortic aneurysm and still be denied any treatment or even a few pennies worth of morphine to address palliatively, at the very least, the pain. However, currently, this is not offered to the poor and uninsured. This is why Mother Teresa of Calcutta made such a name for herself. She offered, for no charge, palliative care to those patients who were, sadly, suffering, writhing, and dying on the streets. However, to our great credit, it is illegal in the US to deny emergency care, regardless of ability to pay.
The concept of preventive care costing less than emergency care is not a difficult concept. In the automotive world, if one doesn’t change the oil, filters, and so on, one will likely destroy the engine quite prematurely which costs many thousands of dollars to replace. If one has an old roof on the house and it is not replaced routinely, this could lead to tens of thousands of dollars’ worth of damage (possibly more) in a character building disaster.
In OMRUM’s 9/15/24 article, an important assertion about better care while saving money was made in a quoted article by author Web Golinkin in Forbes.com. He noted that for every dollar spent on a patient for primary care, the savings would be $13. Using a different format, there would be >1000% return on investment. Using these parameters, let us arbitrarily construct in our mind a program in which the government pays $1000 per year per uninsured citizen. $1000 is very modest when CMS.gov estimates that the average healthcare expenditure in 2023 (the latest available figure) increased to $14,570 per patient per year in the United States (thus, $4.9 trillion total). If those 43,000,000 patients each had $1000 allocated, the government would pay $43,000,000,000 (43 billion). If this program focused heavily on prevention (vaccines, education, well patient checks) and early intervention (hypertension, diabetes, hypercholesterolemia, chronic renal disease, obesity,…) (in other words, a standard primary care model), the United States would actually save $559,000,000,000 ($559 billion). Even this small percentage would be about a 10% reduction in the total cost of care (remember that the total cost for the entirety of the United States was $4.9 trillion) This would happen because the need for ER services would be significantly reduced by either prevention or early intervention. Using wording that has been seen a number of times before, these patients would engage the medical system “upstream” where services are extremely cost-effective, not “downstream”. Emergency room services would not nearly be used as frequently with this type of care.
Another study not previously reviewed in OMRUM is worth noting. In “The Effect of Primary Care Visits on Total Patient Care Costs: Evidence from the Veterans Health Administration” by Jian Gao, et al., in the Journal of Primary Care & Community Health, November 10, 2022 huge savings was uncovered. In this eye-opening study, it was found that an average of $721/patient/year was saved for each in person PCP visit during the year. The 1st visit in the year saved a princely sum of $3976/patient/year while we each subsequent visit saved a lesser amount, ultimately averaging, as noted above, the $721/patient/year. The study is notable because it the Veterans Administration study which allowed costs to be monitored carefully. Also of note, the veteran population is somewhat different than the general population in terms of demographics and pre-existing conditions. Nevertheless, in the veterans’ population and, by extension, the general population, moving care as best as possible away from the emergency room whenever and wherever possible leads to huge improvements in the quality of care and cost-effectiveness.
In summary, dismissing citizens from health insurance coverage will lead to increased costs, not decreased costs. Unless the United States bars people from ER care if they are financially destitute (and may God have mercy on our souls if we do), high-quality, cost-effective care will shift to lower quality, chaotic, and cost ineffective care at the already overworked emergency facilities. The above-described legislation seems destined only to harm the indigent with no benefit financially or otherwise to the general population. We can do better.