Summary Healthcare leaders today face a landscape defined by policy shifts and financial volatility. The impending implementation of the H.R.1 One Big Beautiful Bill Act (OBBBA) and the associated reduction in federal spending present a critical challenge for safety-net providers and payers alike. This article offers a strategic framework for managing this change, drawing on insights from leaders across the payer, provider, and philanthropic sectors. We explore strategies to mitigate coverage loss through targeted outreach, examine how Federally Qualified Health Centers (FQHCs) and Certified Community Behavioral Health Clinics (CCBHCs) must operationalize community health for their survival, and analyze the risks to the broader healthcare delivery system. Finally, we recommend practical leadership approaches to maintain workforce resilience and advocate for systemic sustainability.
Elizabeth Wolff (2026) studied this question.