Behind the Curtain: The One Big Beautiful Bill’s Hidden Blow to Anesthesia Providers in Kansas City
Written by Dr. Jean Covillo, CRNA
Here is the fine print that no one wants to talk about.
Tucked deep within the folds of the One Big Beautiful Bill Act (OBBBA), is a sleight-of-hand move anesthesia providers cannot afford to ignore. The bill, if passed, would indirectly trigger an automatic 4% Medicare cut under PAYGO—on top of the existing 2% reduction—and drag down commercial rates such as those from BCBSKC, which are tied to Medicare. By 2030, anesthesia Medicare rates are estimated at $16.50 per unit, with similarly steep cuts projected for BCBSKC.¹⁻²
Cloaked in polished language that promises significant tax cuts to everyday citizens, the OBBBA quietly dismantles payment structures, shifts burdens, and pushes anesthesia providers to the brink. In Kansas City, where surgical access depends on viable anesthesia care, this is more than policy—it is a vanishing act that could leave CRNAs and anesthesiologists holding an empty top hat.
It is a fiscal trapdoor beneath already collapsing reimbursement floors—one that compounds cuts into a perfect storm of financial pressure, leading to steep salary reductions, loss of business, and reduced access to care.³
1. Immediate Cuts: The 2025 Baseline
Anesthesia providers in Kansas City face a 2.2–2.3% Medicare rate reduction in 2025:
– Non-facility rate: Decreases from $20.61 (2024) to $20.13/unit
– Facility rate: Falls from $19.56 to $19.12/unit
This marks the fifth consecutive year of Medicare cuts, with cumulative reductions exceeding 10% since 2020.¹
2. OBBBA’s Compounding Impact (2026–2034)
The bill’s $3.3 trillion deficit would trigger automatic 4% annual Medicare cuts under statutory PAYGO (S-PAYGO) rules, layering atop baseline reductions.²
Projected Rate Trajectory for Kansas City Anesthesia (Non-Facility):
Year Rate/Unit Cumulative Reduction Drivers
2025 $20.13 2.2% CMS policy
2026 $19.32 6.4% +4% S-PAYGO
2027 $18.55 ~10.6% +2–3% baseline +4% S-PAYGO
2030 ~$16.50 ~20% Compounded cuts
Key implications:
– By 2030, reimbursement would fall below 2008 levels, adjusted for inflation.³
– A typical 10-unit case would yield $36 less revenue than in 2024.³⁻⁴
3. Commercial Payer Domino Effect
Insurers like BCBSKC, which pay 150–250% of Medicare rates, would mirror these reductions:⁴
– 2025 BCBSKC rate: $30.20–$50.33/unit
– 2026 BCBSKC rate: $29.00–$48.31/unit
– Estimated revenue loss: $13,000–$23,000 annually per physician due to combined Medicare and BCBSKC cuts.⁴⁻⁵
4. Systemic Risks
| Threat | Magnitude |
| Rural access collapse | 40% of Missouri’s rural anesthesia providers at risk of closure⁵ |
| Provider attrition | 15% of Kansas City–area anesthesiologists may reduce Medicare volume⁶ |
| Surgery delays | Projected 8–12% increase in wait times for elective procedures⁶ |
5. Legislative Crossroads
– H.R. 10073 (Medicare Patient Access and Practice Stabilization Act of 2024) would reverse the 2025 cuts but cannot block OBBBA-triggered S-PAYGO reductions.⁶
– OBBBA amendments: Only deficit reduction or an S-PAYGO waiver would prevent the 4% annual cuts.²
Conclusion: A Perfect Storm
The OBBBA would transform existing Medicare cuts into a prolonged financial crisis for Kansas City anesthesia providers:
1. Short term: 2.2% cut in 2025 strains practices already battling inflation.¹
2. Medium term: 4% annual cuts beginning in 2026 compound the damage.²
3. Existential threat: By 2030, rates could fall 20% below 2025 levels, risking mass provider exits and reduced surgical access.³
Urgent Priorities:
– Block OBBBA’s deficit expansion.
– Pass H.R. 10073 for immediate relief.
– Decouple commercial payments from Medicare benchmarks.⁷
References
- Centers for Medicare & Medicaid Services. CY 2025 Medicare Physician Fee Schedule Final Rule. 2024.
- Congressional Budget Office. Cost Estimate for the “One Big Beautiful Bill Act.” 2025.
- American Society of Anesthesiologists. Anesthesia Payment Trends Analysis 2020–2025. 2024.
- Blue Cross Blue Shield of Kansas City. Provider Reimbursement Guidelines. 2025.
- Missouri Hospital Association. Rural Anesthesia Access Report. 2025.
- S. Congress. H.R. 10073: Medicare Patient Access and Stabilization Act. 2025.
- Health Affairs. Commercial Payer Payment Linkage to Medicare. 2024.
- S. Government Accountability Office. Medicare Payment Cuts and Provider Viability. 2025.
