Sweeping federal reforms, such as the 2025 HR1, known as the One Big Beautiful Bill Act (OBBBA), are poised to dramatically reshape the patient experience and healthcare delivery. As insurance coverage shifts and Medicaid eligibility tightens, patients and providers alike face deep uncertainty. To prepare and innovate, healthcare leaders must anticipate how patients will respond to these changes. A strategic framework of “Understand, Improvise and Adapt” offers actionable insights for organizations committed to safeguarding access to health for all patients.
Understand: Recognizing the new landscape
Predicted patient actions: Many patients will initially be caught unaware of the full impact OBBBA has on their insurance status or care access. Confused by paperwork or changing requirements, they may not realize their coverage has lapsed until a moment of need. This knowledge gap fosters uncertainty about where to turn for care, especially as eligibility and benefits change with varying implementation dates for aspects of OBBBA. Anxiety about medical bills and a lack of clear information heighten stress for families already struggling to make ends meet.
Healthcare leader response: Addressing this new landscape starts with health literacy for patients and staff. Leaders should launch targeted campaigns to explain new realities, ensuring communications are clear and tailored to local communities. Training teams to proactively identify at-risk patients for individualized navigation, such as those with chronic conditions, unstable employment, or frequent insurance churn, can help avert lapses in coverage and guide patients through changing options. Investing in easy-to-understand materials and access points will be critical to reducing anxiety and uncertainty.
Improvise: Navigating new barriers
Predicted patient actions: When coverage gaps appear, patients improvise. Many begin to ration or forgo medications, limit follow-up appointments, or delay care until conditions are severe, necessitating emergency or urgent care visits. With finances tighter than ever, some will cost-shop for services, seeking discount programs, free clinics or other workarounds to manage health with limited resources. These improvisations, while understandable, introduce increased fragmentation and delays in treatment.
Healthcare leader response: Healthcare organizations should deepen partnerships with community-based organizations, including community health clinics. These are often the primary recourse for the newly uninsured. Forging stronger connections with social care providers, those addressing food insecurity, housing, or transportation, will help connect patients to resources to meet upstream driver mitigation (also known as social drivers of health) and healthcare needs. Clear, up-front pricing for the uninsured can reduce hesitation to seek care due to uncertainty or fear of large bills. Resource guides and streamlined referral pathways can further support patients as they navigate these new barriers.
Adapt: Forging new patterns of care
Predicted patient actions: As system changes settle in, many patients will shift from ongoing relationships with a primary care provider to episodic care, such as using urgent care, ERs or sporadic clinic visits only when necessary. For those with chronic diseases like diabetes or hypertension, this disconnect means losing consistent monitoring, which can lead to complications and hospitalizations. Informal solutions, such as relying on friends, family or online communities for advice and supplies, are likely to increase. In short, patients will be looking beyond the clinic walls for care.
Healthcare leader response: Forward-thinking organizations will augment navigation services across every access point, from EDs to telehealth and clinics, ensuring no patient leaves without connection to follow-up care or community resources. Expanding the use of community health workers (CHWs), peer support specialists (PSS), certified medical assistants (CMAs), and licensed practical nurses (LPNs) creates ongoing personal touchpoints, especially for the intermittently uninsured. Leaders should support the creation and strengthening of community care networks that integrate medical, behavioral and social services through a Community Care Hub. Championing robust data integration efforts, including sharing information across hospitals, clinics and social service organizations, will enable more effective patient tracking, proactive outreach and seamless transitions between episodic and long-term care.
Seizing the moment
The post-OBBBA world demands agility and empathy. As patients move from confusion to improvisation to adaptation, healthcare leaders must be proactive: increasing health literacy, forging new collaborations, supporting community-based care and embracing data integration strategies to mitigate upstream drivers of health will be key. The challenges of rising uninsurance and health inequities are steep, but through coordinated action and focused innovation, health systems can help the most vulnerable patients understand, improvise and ultimately adapt in ways that safeguard care, dignity and trust.
Holly Howat is the founder and executive director of Beacon Community Connections, a community care navigation organization, as well as a consultant with Robinson Ventures.
Cian Robinson is the founder and president of Robinson Ventures, a management consulting and venture capital firm. He previously held innovation leadership roles at McLeod Health and Ochsner Lafayette General.