For years, healthcare reform has arrived in waves, each promising simplification but often introducing new layers of complexity. The One Big Beautiful Bill Act (OBBBA) is the latest and most ambitious attempt to streamline how Americans access, receive, and pay for care.
At its core, the OBBBA is designed to consolidate billing, improve transparency, and unify fragmented systems under one national framework. It seeks to simplify the patient experience by creating a single, standardized bill that spans providers, facilities, and payers. The vision is bold. The execution, however, is creating deep uncertainty for health plans that now face regulatory, operational, and financial disruption on multiple fronts.
Health plans are being asked to adapt quickly, to reconfigure technology, reimagine operations, and anticipate ripple effects that stretch across claims, member engagement, compliance, and workforce strategy. The OBBBA is more than a billing reform. It is a catalyst for structural change across the payer ecosystem.
The promise and peril of simplification
The OBBBA emerged from a genuine desire to fix what has long frustrated members and policymakers alike: the administrative fragmentation of healthcare. Multiple bills, opaque pricing, and inconsistent data standards have driven up costs and eroded public trust.
In theory, a unified billing standard creates a more transparent and patient-friendly system. It could reduce duplicative administrative work, improve claims accuracy, and help patients understand what they owe and why. But beneath the promise of simplification lies a web of operational challenges.
The act requires sweeping updates to billing platforms, data exchange standards, and payment systems. Many states are interpreting OBBBA provisions differently, and implementation timelines are not aligned. Health plans that operate across jurisdictions face uneven regulatory expectations and growing compliance complexity.
Simplification at the member level can translate into disruption at the plan level. The result is a paradox familiar to anyone in healthcare operations: achieving clarity for the consumer often means re-engineering every process behind the scenes.
The current state of health plans: Transformation under pressure
Health plans today are managing extraordinary pressures, even without the OBBBA. Persistent cost escalation, talent shortages, and the fast-paced adoption of new technologies are reshaping the landscape. The OBBBA intensifies each of these challenges.
Cost pressures continue to climb. Medicaid redeterminations have shifted enrollment patterns and margins. Administrative expenses are increasing as plans invest in compliance infrastructure to meet new billing standards.
Global delivery models are being reimagined. The OBBBA’s documentation and oversight requirements are prompting many health plans to evaluate how best to distribute operations across domestic and international teams. Strategic offshoring, supported by advanced automation and secure data frameworks, can enhance scalability and ensure around-the-clock compliance monitoring. The key is not where the work is done, but how seamlessly technology, process, and governance integrate across borders to deliver consistent quality and transparency.
AI and automation are becoming critical to keeping pace with the scale of OBBBA-driven data consolidation. Plans are exploring AI tools to verify claims, identify billing discrepancies, and streamline provider communication. AI and automation, implemented with human-in-the-loop oversight and auditable controls, allow plans to scale OBBBA workloads across domestic and global teams while improving first-pass accuracy, cycle times, and denial prevention.
Health plans are transforming under pressure. The OBBBA, while adding new demands, also presents a pivotal opportunity to accelerate modernization efforts that were already overdue.
The OBBBA’s market ripple effect
Market dynamics are shifting rapidly. The OBBBA arrives at a time of political uncertainty, budget constraints, and evolving member expectations. The recent government shutdown and its reopening only deepened financial unpredictability for many plans already operating with thin margins.
In this volatile environment, the OBBBA introduces both short-term disruption and long-term promise. Health plans must now balance innovation with compliance, and efficiency with equity. The plans that succeed will be those that view this act not as a compliance project, but as a transformation blueprint.
Here are four strategic imperatives for health plans to consider now.
1. Rethink the balance between technology and people
Technology is the enabler that amplifies human capability. Health plans should deploy automation and AI to streamline billing, eligibility, and claims workflows, allowing teams — both domestic and global — to focus on quality assurance, compliance oversight, and member engagement. Plans should deploy automation and AI to remove friction from billing, eligibility, and claims workflows, while redeploying human expertise to oversee quality, compliance, and member engagement.
The OBBBA’s data and interoperability requirements demand investment in modern infrastructure and in the workforce that operates it. Upskilling staff, integrating compliance monitoring into daily workflows, and creating cross-functional teams that bridge technology and operations will be essential.
2. Integrate financial and strategic planning
The OBBBA will alter revenue timing, claims adjudication cycles, and administrative cost structures. Plans must align financial forecasting with implementation milestones and stress-test their budgets against varying state interpretations and timelines.
Scenario planning is now a strategic necessity. Leaders should ask:
- How will the OBBBA’s phased rollout affect our reimbursement flow and reserves?
- What capital investments in technology and compliance offer the greatest long-term value?
- How can we adapt pricing and risk strategies to reflect billing transparency and potential payment lag?
Aligning finance, operations, and policy teams will ensure that compliance readiness also supports fiscal stability.
3. Reframe member engagement and education
The OBBBA’s single-bill concept offers an opportunity to rebuild trust with members, but only if plans communicate clearly and empathetically. Members must understand how the new billing process works, why it matters, and how it benefits them.
Health literacy and transparency are now competitive advantages. Plans that simplify explanations, provide multilingual support, and personalize outreach will build confidence and loyalty. In an era of public skepticism toward the healthcare system, education is engagement.
4. Expand and empower compliance teams
The OBBBA increases reporting, auditing, and data-validation requirements. Compliance teams must scale accordingly. Rather than simply monitoring adherence, tomorrow’s compliance professionals must partner with technology, finance, and operations to shape implementation strategies.
Integrating real-time data tools, predictive analytics, and process dashboards will allow teams to anticipate issues before they become violations. A proactive compliance model builds resilience and protects member trust.
From disruption to direction
The OBBBA represents a profound shift in how our healthcare system defines accountability. While it introduces significant short-term disruption, it also paves the way for greater transparency, simplicity, and equity, values the industry has long pursued but struggled to achieve.
Health plans now stand at a crossroads. Those who see the OBBBA as an obstacle will expend resources reacting to change. Those who see it as an inflection point will use it to modernize, retool, and strengthen their connection to members and communities.
In the next year, the difference between resilience and fragility will be defined by how well plans align their technology, people, and strategy with this new era of unified billing. The work will be complex, but the reward, a more transparent and trusted healthcare system, is worth it.
This is the moment for health plans to lead with clarity, creativity, and courage. The OBBBA may be “one big, beautiful bill,” but its success will depend on whether we build one big, beautiful system to support it.
Photo: Feodora Chiosea, Getty Images
Suraya Yahaya is the President and Chief Executive Officer at HealthAxis, leading the company’s growth and strategic vision with a commitment to innovation and operational excellence. Named CEO in October 2024, Suraya has played a pivotal role in driving HealthAxis toward new frontiers of healthcare technology and service delivery since joining as President and Chief Operating Officer in November 2023.
With over 20 years of experience in the healthcare and technology industries, Suraya brings a deep understanding of business operations, fostering a culture of collaboration, open communication, and clarity. Her leadership focuses on empowering both clients and employees to achieve success through operational efficiency and forward-thinking strategies.
Her extensive experience includes serving as Chief Operating Officer and Integrator at Catalyst Solutions, as well as holding various fractional Chief Operating Officer roles at several start-ups and high-growth companies. She holds a law degree from the University of Liverpool in the UK and an MBA from Regis University.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.
