Broker Update: OBBBA Insights, Sana State Expansion, and CMO News
The One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, is a sweeping reconciliation package that blends tax and spending reforms—including major changes to healthcare. For brokers handling individual, ACA, Medicaid, or group plans, this legislation introduces both immediate shifts and long-term implications [ASA].
A key component, Title II: The American Healthcare Choices Act of 2025, embeds deregulation and tax changes directly affecting benefits markets—elevating broker roles from compliance facilitators to strategic advisors in a competitive landscape. [Congress]
This blog breaks down what’s changing, compares the “before” vs. “after,” and highlights what it means for your clients and commissions.
The ACA and CAA era was about compliance. This next chapter? It’s all about open competition. And as a broker, your role is about to evolve—fast.
Medicaid Changes
The bill’s Medicaid overhaul introduces stricter eligibility rules, including work and income verification requirements. While this shrinks public coverage rolls, it also creates a surge of newly uninsured individuals, many of whom will turn to brokers for help finding new plans.
Before: Brokers rarely engaged with Medicaid enrollees, as most were covered automatically or through government outreach.
After: New rules require verification of income and work status, pushing ~7.8 million people off Medicaid by 2034 [KFF]. Many will seek individual ACA coverage, employer-sponsored plans, or short-term options—markets where brokers are essential.
This is a massive opportunity for brokers:
Why Brokers should care:
Medicaid may not have been your market before. But starting now, it absolutely is.
ACA Marketplace Shifts
The ACA isn’t going away, but it’s changing fast. From disappearing subsidies to shortened enrollment windows and heightened fraud enforcement, brokers who rely on marketplace sales must prepare for leaner margins, faster deadlines, and higher compliance standards.
Before: ACA plans offered enhanced subsidies, broad access, and a long open enrollment season through January 15.
After:
Why brokers should care:
Expect a surge in client questions, tighter eligibility rules, and an uptick in compliance headaches.
Employer-Sponsored Plans & Telehealth
Employers offering high-deductible plans just got a win: telehealth pre-deductible coverage is now permanently allowed. This change makes HDHPs more flexible and gives brokers new value to spotlight when designing or pitching group plans.
Before: The IRS telehealth “safe harbor” for HDHPs had expired in 2024, limiting coverage flexibility.
After: The bill makes the safe harbor permanent and retroactive to January 1, 2025 [Senior Market Sales].
Why brokers should care:
This opens the door for employers to offer first-dollar telehealth without jeopardizing HSA eligibility—an attractive benefit for cost-conscious groups.
Rural Hospital & Provider Landscape
Rural healthcare access has long been fragile. With new funding allocated to rural hospital but deep Medicaid cuts still on the table, the stability of networks in less populated areas remains uncertain. Brokers in these regions should stay alert to shifting coverage landscapes.
Before: Rural providers were under threat from ongoing Medicaid underfunding and provider consolidation.
After: A $50 billion Rural Hospital Fund aims to stabilize care access [Health Action Council]. But Medicaid cuts may still undermine rural coverage in the long term.
Why brokers should care:
Brokers in rural markets must stay in tune with network shifts, hospital partnerships, and potential plan exits.
Administrative & Compliance Burden
This bill doesn’t just reshape coverage, it increases scrutiny. With new verification rules and aggressive oversight, brokers now face a heightened risk of audits and suspensions. Operational discipline and documentation have never been more important.
Before: Brokers dealt with income checks mainly on the ACA side. Medicaid enrollment was largely passive or state-managed.
After: Both Medicaid and ACA now carry stricter verification requirements and heavy broker oversight. CMS is actively auditing agents and suspending licenses for noncompliance [Washington Post].
Why brokers should care:
Broker operations must modernize. Compliance systems, documentation protocols, and staff training are no longer optional.
Key Broker Takeaways:
These policy shifts aren’t abstract—they directly affect a broker’s book of business. Whether you sell individual ACA plans, worksite benefits, or group coverage, the One Big Beautiful Bill brings both risk and opportunity. This section breaks down the big takeaway, and what smart brokers should do next.
Health Plan State Expansion
Sana continues to grow, expanding our level-funded plans into new states to bring better, simpler benefits to more small businesses.
NEW! Sana Health plans are now live: IA, CO, DE, MD, PA
NEW! Sana Care Now Live: IA, WA, DE, MD, MI, NJ, PA
Network Expansion
We added a top hospital system to our network this month, giving clients expanded access to high-quality care.
Located in Arizona: all facilities, providers, hospitals, and urgent care centers
Announcing Sana's Chief Medical Officer
Dr. Grace Hunter, MD, joins Sana as CMO, bringing a deep commitment to health equity and over a decade of leadership in clinical care and public health. A board-certified Internal Medicine physician, Dr. Hunter holds an MD/MBA from Stanford and an MSc in Public Health from the London School of Hygiene and Tropical Medicine.
She’s led care transformation efforts for underserved populations in California and most recently served as CMO at Miga, a virtual clinic focused on cardio metabolic care. She continues to see patients at a free clinic in Jackson, WY.