May 23, 2025

The U.S. House passed H.R. 1, known as the One Big Beautiful Bill Act, May 22, by a largely party line vote of 215 in favor, 214 opposed, with one member voting present.

Although there were several changes to the bill made prior to the final full House vote, a provision that would add $9 billion in new spending to the Medicare Physician Fee Schedule via an inflation-based update to the conversion factor remained unchanged.

Changes to the Medicaid program in the bill would move the start date for work requirements from Jan. 1, 2029, to Dec. 31, 2026, and expand the criteria for states that could lose a portion of their federal payments if they offer coverage to undocumented people.

The bill now advances to the U.S. Senate. Senators will have an opportunity to amend the legislation to reflect their priorities. Majority Leader John Thune (R-SD) has indicated he’d like to pass the bill by July 4.

The American College of Radiology® (ACR®) closely monitored the House proceedings as the legislative text and its healthcare provisions worked through the House and will continue its review as the bill wends through the Senate.

If you have questions, contact Rebecca Spangler, ACR Senior Government Affairs Director.

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