On July 4, 2025, President Donald Trump signed the One Big Beautiful Bill Act (OBBBA) into law, enacting sweeping changes to the U.S. healthcare system. The legislation, passed by a Republican-controlled Congress, includes approximately $1 trillion in cuts to Medicaid over the next decade, resulting in an estimated 11.8 million Americans losing health insurance by 2034, according to the Congressional Budget Office (CBO). This loss of coverage, equivalent to the population of Ohio, poses a devastating challenge for low-income families, rural hospitals, and urban safety-net providers.
For Americans seeking affordable medications, the impact is particularly acute. Without insurance, the cost of prescription drugs can be prohibitive, pushing many to forgo essential treatments. However, this crisis also presents an unprecedented opportunity for healthtech entrepreneurs. The market shift created by this uninsured crisis is estimated at $50 billion, driven by the need for affordable care and medications.
The Impact of the One Big Beautiful Bill Act
The OBBBA introduces significant changes to Medicaid, the Affordable Care Act (ACA), and other safety-net programs. Key provisions include:
- Medicaid Work Requirements: Starting in January 2027, Medicaid enrollees in the 40 states and Washington, D.C., that expanded Medicaid under the ACA must prove they are working, volunteering, or attending school for at least 80 hours per month. Exemptions exist for pregnant individuals, people with disabilities, and caregivers, but the CBO estimates that 10.3 million people will lose coverage due to these requirements and other restrictions, such as more frequent eligibility redeterminations.
- Medicaid Funding Cuts: The bill reduces federal Medicaid spending by $930 billion to $1.1 trillion over 10 years, with savings derived from work requirements ($326 billion), limits on state provider taxes ($191 billion), and restrictions on state-directed payments ($149 billion). These cuts will strain hospitals, particularly in rural areas, where over 300 facilities are at immediate risk of closure.
- ACA Marketplace Changes: The OBBBA eliminates automatic reenrollment, shortens the open enrollment period to November 1–December 15, and ends low-income special enrollment periods. Enhanced premium tax credits, set to expire at the end of 2025, are not extended, leading to an estimated 4.2 million additional uninsured individuals.
- Immigrant Eligibility Restrictions: Lawfully present immigrants, including refugees and asylees, will lose eligibility for Medicaid, ACA subsidies, and SNAP, further exacerbating coverage gaps.
These changes will increase uncompensated care costs for hospitals by $31 billion by 2034, with emergency rooms (ERs) facing a surge in visits from uninsured patients unable to afford preventive care or medications. For low-income Americans, the loss of Medicaid coverage means higher out-of-pocket costs for prescriptions, with a family of four potentially facing up to $1,650 annually in new healthcare expenses.
The Crisis in Prescription Drug Access
Medicaid currently covers nearly 80 million Americans, including 40% of all births and over 60% of nursing home residents. For many, Medicaid provides free or low-cost prescriptions, making the loss of coverage a significant barrier to medication adherence. A 2025 KFF poll found that 68% of Medicaid enrollees say it would be “very difficult” to afford prescription medications without coverage, with 75% reporting a “major impact” on their financial well-being.
In the U.S., prescription drug prices remain among the highest globally. For example, a 30-day supply of insulin can cost $300–$400 without insurance. Similarly, common medications like atorvastatin (Lipitor) or metformin can cost 5–10 times more in the U.S.
The $50 Billion Healthtech Opportunity
The uninsured crisis creates a $50 billion market opportunity for healthtech entrepreneurs, driven by the need for affordable healthcare and medications. The shift from insurance-driven care to patient-driven solutions empowers individuals to seek cost-effective options. Healthtech innovations can address both immediate needs (e.g., prescription access) and systemic challenges (e.g., hospital efficiency). B
1. Medical Payment Plans
Solution: Develop financing platforms that allow uninsured Americans to pay for healthcare and medications over time, similar to Klarna or Afterpay in retail.
Details:
- Platform Features: A user-friendly app where patients input their prescription needs, receive a quote for medications, and select a payment plan (e.g., 3–12 months). AI-driven credit assessments ensure accessibility for low-income users.
- Example: A patient needing $300/month for insulin could pay $25/month over 12 months with low or no interest, subsidized by state innovation funds or pharmacy partnerships.
- Impact: Reduces medication non-adherence, which costs the U.S. healthcare system $100–$300 billion annually.
Implementation:
- Partner with U.S. fintech companies to handle payment processing and compliance with HIPAA and FDA regulations.
- Leverage state innovation funding ($5–10 billion annually) to subsidize interest rates or cover administrative costs.
- Market to uninsured populations through social media and community health centers, emphasizing savings and ease of access.
2. Comparative Healthcare and Pharmacy Marketplaces
Solution: Create transparent platforms where uninsured patients can compare prices for medications, doctor visits, and procedures.
Details:
- Platform Features: A marketplace listing pharmacies, telehealth providers, and low-cost clinics with upfront pricing. Filters allow users to sort by cost, quality ratings, and delivery times. Integration with telehealth ensures prescriptions can be issued remotely.
- Impact: Empowers patients to make informed decisions, reducing costs for medications. Transparency drives competition, lowering prices across the board.
3. Hospital Efficiency Tools
Build AI-driven tools to help hospitals reduce costs while serving uninsured patients, with integrated medication cost-saving features.
Details:
- Platform Features: AI tools for predicting readmissions, optimizing staff schedules, and streamlining billing. Hospitals can aim to increase purchasing of generics, reducing medication costs for uninsured patients.
- Example: A rural hospital uses the platform to identify high-risk patients, provide telehealth follow-ups, and supply generics at discharge, reducing readmissions by 20% and medication costs by 60%.
- Impact: Saves hospitals $2.8 million annually per facility by reducing uncompensated care, based on 2016 ACA expansion data. Improves patient outcomes by ensuring medication access.
State Innovation Funding: A Catalyst for Change
States are responding to the uninsured crisis with $5–10 billion annually in innovation funding, aimed at supporting healthtech solutions. Examples include:
- California: Allocating $2 billion for telehealth and prescription access programs to serve uninsured immigrants and low-income residents.
- New York: Investing $1.5 billion in hospital efficiency tools to reduce uncompensated care costs.
- Texas: Providing $800 million for rural hospital stabilization, including medication cost-saving initiatives.
Solution providers can tap into these funds by partnering with U.S. healthtech firms and state agencies. Proposals should emphasize cost savings, scalability, and improved outcomes for uninsured populations.
The Broader Implications: A Patient-Driven Healthcare Future
The OBBBA marks a shift from insurance-driven to patient-driven healthcare. Without Medicaid or ACA subsidies, patients will seek cost-effective solutions and innovative healthtech platforms. This transition empowers consumers but requires robust infrastructure to ensure access and affordability.
By integrating with U.S. healthtech ecosystems, providers can offer holistic solutions—payment plans, marketplaces, and hospital tools—that address the full spectrum of uninsured needs. This not only captures market share but also aligns with the mission to save lives.
The One Big Beautiful Bill Act’s $1 trillion Medicaid cuts have created a healthcare crisis, leaving 11.8 million Americans uninsured and driving a $50 billion market opportunity. This is a chance to lead with innovative solutions—medical payment plans, comparative marketplaces, hospital efficiency tools, and prescription discount programs—that deliver affordable medications and comprehensive care.
By leveraging state innovation funding providers can look to save Americans billions while improving health outcomes. The time to build is now, not just to capture market share but to ensure that no American goes without life-saving healthcare. Healthtech entrepreneurs have a moral and economic imperative to act swiftly, transforming this crisis into a new era of patient-driven healthcare.