Evaluating and monitoring health policy is critical to tracking impacts and outcomes of legislative changes and reform. Establishing a strategic plan from the beginning of implementation is essential, as it allows for phased and realistic timelines, standardized data collection, and opportunity to be flexible and responsive to findings; this is perhaps especially true with policy that implements large-scale changes across agencies and federal programs, such as the budget reconciliation bill, H.R. 1.
What Is H.R. 1?
H.R. 1, also colloquially known as HR1 or the One Big Beautiful Bill Act (OBBBA), was signed into law on July 4, 2025, and includes sweeping changes to Medicaid and Affordable Care Act (ACA) Marketplaces over the next four years.
Just some of the changes enacted by H.R. 1 include:
- Implementation of work requirements for Medicaid enrollees
- Reduction in federal funding for Medicaid
- New rules on eligibility for Medicaid and Marketplace plans, including more frequent redeterminations and address verifications
- Potential changes to open enrollment periods
Considerations for Monitoring Impacts of H.R. 1
With such widespread changes to the health insurance landscape in the United States as a result of H.R. 1, understanding impacts to enrollment, expenditures, eligibility, and operations is essential. In order to understand these impacts, states need to develop a monitoring strategy that outlines priority areas to track, data that needs to be collected, and how this information will be analyzed and reported on. This strategy should capture impacts in both the short- and long-term, and should be able to record and track changes and trends as they occur.
In a recent publication published by State Health & Value Strategies (SHVS), SHADAC authors Elizabeth Lukanen and Emily Zylla provide key considerations, templates, and guidance for states looking to create a standardized, detailed, and effective monitoring strategy. Find this publication in full here on the SHVS website.
SHADAC is also available to provide tailored technical assistance to states, agencies, and other organizations. Contact us here with any questions or inquiries.