H.R.1 Action Plan: What Healthcare Leaders Need to Know Now
October 6, 2025
Performance Transformation
The passage of H.R.1 introduces sweeping Medicaid work and community engagement requirements. These changes affect beneficiaries and threaten the financial foundation of hospitals and health systems nationwide. Analyses from the Commonwealth Fund estimate that hospital operating margins could decline by 11.7 to 13.3 percent under H.R.1’s Medicaid work requirements, with rural and safety-net hospitals facing the steepest risks.
During our recent webinar, H.R.1 Action Plan: Practical Advice to Start Preparing Now, Coker’s team of experts — Dan DeBehnke, Paul Weintraub, Pat Wulf, and Brantley Kilgore — explored how organizations can navigate coming changes with foresight and proactivity. The discussion blended financial realism with practical strategy, offering healthcare leaders a roadmap to mitigate risks and build resilience.
Understanding the Impact of H.R.1
Moderator Dan DeBehnke underscored the urgency of the situation:
“Given that many provider organizations already operate on narrow margins, this policy shift carries meaningful risk for service stability, access to care, and strategic positioning.”
The panelists broke down the financial and operational impacts possible across different hospital types – from rural hospitals facing possible service cuts to safety-net hospitals absorbing higher uncompensated care to large systems adjusting payer strategy to offset headwinds.
Preparing Revenue Cycle and Compliance Functions
Pat Wulf emphasized the operational risks associated with changing requirements:
“Revenue cycle teams will need to prepare for new coverage verification challenges and patient access issues. Denials will rise if you don’t get ahead of this.”
The panel stressed that compliance is not optional under H.R.1. Hospitals must strengthen documentation and perform vigilant fair market value diligence to protect against regulatory scrutiny.
Balancing Defense and Growth
Paul Weintraub urged leaders not to retreat into pure cost cutting:
“You can’t afford to only play defense. H.R.1 should be a catalyst to rebalance revenue, rethink payer contracts, and position for sustainable growth.”
Leadership and Workforce Readiness
Brantley Kilgore highlighted proactive leadership behaviors:
“Organizations that flatten decision making and embrace accountability will adapt fastest. Communication and expectation setting are critical right now.”
The panel closed with practical advice. As Dan summarized:
“Success under H.R.1 isn’t about theory. It’s about having executable roadmaps, stress-tested scenarios, and guardrails you can take into board discussions tomorrow.”
