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EP Implications of New Budget Bill

Congress and the President have recently passed the "One Big Beautiful Bill," and there are several provisions that impact the field of EP.

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Major Medicaid Cuts & Work Requirements

The bill implements sweeping reductions to Medicaid and tightens eligibility rules:

  1. Nearly $1 trillion in cuts to Medicaid over the next 8 years.

  2. Enforces strict work requirements for Medicaid recipients, including those with children over the age of 14.

  3. Establishes mandatory Medicaid eligibility audits and compliance reporting.

  4. Blocks Medicaid access for certain non-citizen populations and prohibits coverage of gender-affirming care—though some of these provisions may be legally or procedurally challenged.

  5. The Senate parliamentarian previously struck down several state-level Medicaid expansions from being included under reconciliation rules.

Implications for Electrophysiologists:

  1. A projected drop in Medicaid enrollment may directly reduce the number of covered patients receiving EP procedures such as ablations, ICD implants, or hospital-based EP studies.

  2. Tighter eligibility rules increase uncompensated care burdens, particularly in urban safety-net hospitals and rural regions where Medicaid serves as a primary payer.

  3. Reduced reimbursement could strain clinical programs that rely heavily on Medicaid funding, especially pediatric and public academic EP centers.

Rural Hospital Support: Temporary Relief, Long-Term Gaps

To mitigate rural backlash, the bill includes targeted, but time-limited, support for rural providers:

  1. $50 billion in funding for rural hospitals through FY2030, including a $25 billion “Rural Health Transformation Fund.”

  2. States must apply to access funds by 2027, with money distributed both evenly and at CMS discretion.

  3. Funds may be used for hospital stabilization, care delivery redesign, or workforce development—but specifics will depend on state plans.

Despite this injection:

  • The support expires after 5 years, while permanent Medicaid cuts continue into the next decade.

  • Analysis from the National Rural Health Association (NRHA) estimates that the rural funds will offset only ~43% of rural Medicaid losses under the bill.

Implications for Electrophysiologists:

  1. Short-term support may sustain rural EP referral centers or shared services programs.

  2. However, longer-term viability of rural access to EP diagnostics and procedural care remains at risk unless further funding is enacted.

  3. Programs like remote monitoring, mobile EP clinics, or regional EP partnerships may gain relevance as rural hospitals adapt.

Medicare Adjustments: Cuts and Limited Enhancements

The legislation imposes cost-saving measures on Medicare:

  1. A 4% across-the-board cut to Medicare spending beginning in FY2026.

  2. Medicare Advantage and traditional fee-for-service programs are both affected.

  3. Early House-passed features like enhanced HSA flexibility for working seniors and AI-driven Medicare fraud detection were stripped out in the final Senate version.

Implications for Electrophysiologists:

  1. Reimbursement rates for EP services—including common procedures like AF ablation, pacemaker/ICD implantation, and EP testing—could be reduced.

  2. Tighter margins may discourage hospital systems from expanding EP services or hiring.

  3. Value-based care models could be more aggressively promoted as a cost-control strategy.

Bottom Line for the EP Community

Electrophysiologists face a shifting landscape under the newly passed legislation:

  

  • Temporary Wins: Rural hospital funding may buffer immediate losses and sustain access to EP services in underserved areas.

  • Sustained Risks: Deep Medicaid cuts and eligibility restrictions threaten coverage and reimbursement, and Medicare payment reductions are likely to reduce margins and constrain innovation or expansion in EP services.

  

Advocacy Focus Areas 

HRA remains committed to advocating for electrophysiology professionals and the patients they serve. Our plan includes:

  

1. Engaging Federal Lawmakers

  • Advocating for Medicaid and Medicare rate protections for essential cardiac services.

  • Pushing for waivers or flexibility that sustain Medicaid coverage in states with high EP patient loads.

2. Emphasizing Rural EP Needs

  • Highlighting EP’s role in preventing cardiac hospitalizations and reducing mortality in rural populations.

  • Promoting tele-EP and remote monitoring as critical tools for rural hospital sustainability.

3. Monitoring Implementation

  • Working with state Medicaid agencies and CMS to shape how rural hospital funds are used.

  • Tracking regulatory changes to Medicare payment models and prepare to adapt EP program delivery.

 

Advocacy Matters Now More than Ever

HRA, the advocacy voice of HRS, is focused on influencing lawmakers to protect coverage for EP services and sustain patient access to essential cardiac care. Your support is critical: join HRA and consider making a donation to fund this important work.

  

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