Blog Contribution by NIHD President Kevin Meek RN-BSN, BA, MHI, EDAC, FACHE
The "One Big Beautiful Bill Act," passed in early July 2025, represents the most sweeping overhaul of U.S. healthcare funding in decades. It included over $1trillion in Medicaid cuts over 10 years, with stricter state financing rules that limit provider taxes. Additionally, with higher copays and a projected loss of coverage for 11.8 million Americans by 2034, there is an accelerated risk of closure for rural hospitals, with hundreds facing a fiscal cliff due to reduced reimbursements. This severe financial strain on Safety Net Hospitals, which rely heavily on Medicaid and state-directed payments, will certainly have an impact on how health systems approach their assets and facilities. Regardless of where we stand politically, or whether we believe the recent overhaul is the right step or not, one thing is for certain, the healthcare landscape in our country is changing.
Norton Sound Regional Hospital in Nome, which serves Nome and the surrounding villages of the Bering Strait region, is a 18-bed Critical Access Hospital, which also includes outpatient and ancillary services.
While NIHD remains non-partisan and does not have a political action committee, we cannot help realizing that these implications of reimbursements and financial pressures will cause healthcare systems to reevaluate how they approach projects and where revenue dollars are spent. As such, our role as clinical advisers becomes even more crucial and important to the overall operational model for our facility, or the facilities that we work with on a daily basis. Ensuring that every dollar spent on design and construction results in a direct impact to overall positive patient outcomes, and that we are able to tie return-on-investment (ROI) to each initiative we propose will be critical. The data and analysis we use in supporting our teams will become key in demonstrating the rationale for the recommendations we suggest for projects and the impact they have to the care team and built environment.
How Americans receive and pay for medical care is changing, whether it’s today or in the short-term, and how facilities are designed to handle that shift is changing too. For healthcare construction, we anticipate projects already approved, especially those with private funding or long-term capital plans, are still likely to proceed. Rural and safety-net hospital projects may stall or be canceled all together while leadership determines the true financial impact to their organizations. Regardless, we can expect increased scrutiny of ROI, patient throughput, and operational efficiency indesign proposals, as well as more strategic planning to pivot toward outpatient, specialty, or private-sector healthcare facilities. There will likely also be a significant increase in demand for renovation and optimization over new construction to gain more optimization of existing assets.
Below are some links for position statements from nursing and healthcare organizations. NIHD does not support or endorse any particular view and remains focused on how we engage and integrate clinical expertise into the planning and design of built healthcare environments.
American Nurses Association: ANA Warns Senate’s HR1 Bill ‘Devastating’ for Patients and Nurses
American Academy of Nursing Statement on the Passage of the One Big Beautiful Bill Act
American Hospital Association: Fact Sheet: One Big Beautiful Bill Act Would Significantly Reduce Availability of Coverage inthe Health Insurance Marketplaces
Advisory Board: $1T inhealthcare cuts: What 'One Big Beautiful Bill Act' means for the industry
Becker’s Hospital Review: One BigBeautiful Bill Act fallout: Health system CEOs brace for change