Panel discusses the projected effects of OBBBA on family physicians, patients in keynote address at TAFP’s Annual Session and Primary Care Summit

To kick off the general session for this year’s Annual Session and Primary Care Summit, the Academy’s CME planning committee opted to feature a panel discussion on a provocative and timely topic: “The One Big Beautiful Bill Unpacked — What It Means for Family Physicians, Patients, and the Future of Health Care.” TAFP CEO Tom Banning moderated an expert panel comprised of:

• Mark Chassay, MD, MEd, MBA, who is the chief medical officer at Blue Cross and Blue Shield of Texas;
• Todd Thames, MD, MHA, a professor of Practice in Health Care Administration at Trinity University in San Antonio; and
• Jenna Hemmingway, the senior vice president of platform and growth at Catalyst Health Group, the largest network of independent primary care physicians in Texas.

The One Big Beautiful Bill Act, also known as H.R. 1 of the 119th Congress, was signed into law on July 4, 2025, and it contains hundreds of provisions including many that will affect the health care industry.

Thames, who is a family physician and teaches health care policy and bioethics, began the discussion by telling attendees that there are parts of the OBBBA that will be detrimental to access to care for many patients, and there are other provisions that could be beneficial to health care delivery and financing. “But I think the most impactful thing that I see is we are having a conversation about health care right now in America that is a little bit unique,” he said, “and as primary care physicians, specifically as family medicine physicians, we are uniquely positioned to take advantage of that conversation.”

The Congressional Budget Office has projected that due to various provisions in the OBBBA, as many as 15 million Americans could lose health care coverage by 2034. Most of those losses will come from Medicaid due to new reporting requirements, shorter renewal periods, and mandatory work requirements, among other provisions.

Changes to the Affordable Care Act Marketplace plans are projected to affect coverage for millions of people as well. The OBBBA shortened the open enrollment period and eliminated automatic reenrollment, and it did not include extending the ACA’s enhanced premium tax credits, which will cause out-of-pocket costs to skyrocket for many enrollees.

Among the positive aspects of H.R. 1 the panelists discussed were changes to health savings accounts, or HSAs, and what they mean for physicians wanting to contract directly with individuals and employers. As of January 2026, patients can use money from their HSAs to pay for direct primary care services, something the Academy and other members of the Direct Primary Care Coalition have been trying to pass for at least 10 years.

Hemmingway said Catalyst Health Group views the changes to HSAs and to the employer-sponsored insurance market as potentially beneficial for patients and physicians alike. “As you think about packaging high-deductible plans with the One Big Beautiful Bill Act allowing for subscription payments month over month for services, it actually brings primary care to the center of the conversation with employers,” she said.

Chassay said these changes will likely push health plans to experiment more with advanced primary care and other alternative models. “It is paramount to have primary care at the center of all this care,” he said. “The employers, their CEOs, their CFOs, and their boards of directors are looking at the costs that are going up, so they're looking at all the ways that they can redesign their [employee] benefits.... It's a huge change.”

For more information on H.R. 1, check out AAFP’s summary of the act.