By Courtney Beckers | National Account Executive, Hines & Associates
Federal budget changes rarely dominate the national conversation around self-funded health care—but that’s about to shift in a significant way. The recent passage of H.R. 1—the so-called “big, beautiful bill”—ushers in a new era of sweeping fiscal reform, with enormous implications for Medicare and Medicaid. These cuts don’t exist in a vacuum; they reverberate across the entire health care ecosystem and place mounting pressure on employers, third-party administrators, and, ultimately, the employees they serve.
Medicare is preparing to absorb $490 billion in reductions over the next ten years, with an automatic 4% decrease in annual provider payments starting in 2026, as mandated by PAYGO (Pay-As-You-Go) rules. In parallel, Medicaid is facing an equally staggering blow—up to $716 billion in federal support cuts, laying the groundwork for one of the most substantial contractions in public health funding we’ve seen in a generation.
When foundational public health programs like Medicare and Medicaid shrink, the need for medical care doesn’t decrease. It simply moves—and it moves fast. What follows is cost-shifting, a long-observed economic phenomenon where health care providers make up for lost revenue from public plans by charging more to commercial and employer-sponsored plans. As a result, self-funded employers find themselves footing a larger share of the nation’s health care bill through higher negotiated rates, inflated network pricing, and a rise in catastrophic claims.
And the impact is not just economic—it’s deeply personal. Estimates suggest 4.6 to 10 million Americans could lose Medicaid coverage, depending on how eligibility reforms are rolled out. Those individuals don’t stop needing care. Some will fall into coverage gaps, delaying treatment until symptoms become emergencies. Others will migrate into employer-sponsored plans, often with undiagnosed or unmanaged chronic illnesses, mental health conditions, or long-overdue medical interventions. This influx of high-risk members contributes to a growing wave of delayed and complex care needs, which are among the most expensive to manage.
These challenges put severe strain on employer health plans. Risk pools destabilize. Premiums surge. Employers are forced to consider tough choices around plan design, deductible structures, cost-sharing models, or even coverage limitations. The old model of reactive health care no longer applies—it’s time for a more strategic, data-driven, and future-focused approach to health care management.
At Hines & Associates, we’re already navigating this shifting terrain. We partner with self-funded plans across the country, offering comprehensive solutions such as disease and case management, care coordination, and steerage to high-value bundled payment providers. Our model ensures members get the right treatment, at the right time, with the right outcomes—but that’s just the beginning.
Proactive Care Through Biometric Triggers: Stopping Disease Before It Starts
We’re leading the charge into predictive and preemptive care. We harness real-time biometric data from wearable health technology to gain unparalleled insights into our members’ well-being. By monitoring biomarkers such as heart rate variability, glucose levels, respiratory patterns, and circadian rhythms, we’re able to identify early deviations from healthy baselines.
This enables our clinical teams to act on early warning signs of conditions like diabetes, heart disease, hypertension, and even certain types of cancer—sometimes before the member is even aware of symptoms. These real-time alerts prompt timely outreach, lifestyle interventions, medication adjustments, or referrals to specialists, all aimed at preventing acute events and reducing the cost and complexity of treatment down the line.
This is more than innovation—it’s a redefinition of what care can be. Preventing disease before it starts not only protects lives but also significantly lowers claim costs, improves productivity, and enhances overall employee engagement. It’s a win-win strategy that elevates both clinical outcomes and financial sustainability.
The implications of H.R. 1 are vast. The anticipated shifts will transform member demographics, accelerate the rise in catastrophic claims, and test the resilience of employer-sponsored benefit structures. The most successful organizations will be those that prepare now—with smart data analytics, nimble partnerships, and a commitment to proactive care models that can flex with changing demands.
If your plan isn’t fully equipped to face what’s ahead—or if you simply want a more forward-thinking conversation about strategy—Hines is here to help. We’ve engineered our solutions to be adaptable, scalable, and personalized to meet the unique challenges of a volatile health care environment. Let’s talk about how we can help your plan thrive—not just survive—the road ahead.
