The OBBBA may have been designed to tame federal spending, but for providers it's poised to destabilize the very hospitals caring for the nation's most vulnerable patients.
In our January 2026 HealthLeaders cover story, CFO editor Marie Defreitas examines why the One Big Beautiful Bill Act (OBBBA) is shaping up to be one of the most consequential financial threats hospitals have faced in decades.
While the deepest Medicaid reimbursement cuts won’t take effect until 2027, finance leaders say the damage is already being modeled across workforce planning, capital strategy, credit ratings, and access to care.
Drawing on candid interviews with April Audain, CFO of Denver Health, Brett Tande, CFO of Scripps Health, and healthcare economist Mark V. Pauly of the Wharton School, the story reveals how CFOs are confronting an uncomfortable reality: there are fewer levers left to pull, and many of the hardest decisions, like staffing reductions, service-line contraction, delayed investment, are no longer hypothetical.
Don't miss this roadmap for how hospital finance leaders are preparing for a delayed but destabilizing shock, why advocacy is no longer optional, and what it will take to protect the healthcare safety net when federal austerity collides with rising patient need.
Read the full story here.
Amanda Norris is the Director of Content for HealthLeaders.
KEY TAKEAWAYS
The OBBBA isn’t a future problem, it’s a delayed shock. While the deepest Medicaid cuts won’t hit until 2027, CFOs are already modeling workforce reductions, credit risk, and service-line contraction as if the clock is ticking.
Labor and capital are where the pain will surface first. With staffing costs locked in and capital markets watching closely, hospitals have fewer levers than ever to absorb reimbursement cuts without reshaping care delivery.
Survival is becoming a strategic exercise, not a financial one. From partnerships to advocacy to targeted technology investments, CFOs are being pushed into public, political, and strategic roles they were never expected to play.