Building Solid Healthcare Equity in the Post-OBBBA Era

The One Big Beautiful Bill Act (OBBBA) of 2025 came with one of the biggest legislative overhauls in U.S. healthcare. 

And just like with any great change, the bill created a wave of uncertainty, permeating not just in households, but also in the small business space. This is heightened by growing concerns that people under certain socioeconomic groups (e.g., low-income workers and minorities) will be disproportionately affected, threatening healthcare equity. 

In this post, we'll explore how startups and small businesses can build an equitable healthcare structure within their organization. 

But first, let's review what healthcare equity really means (and why businesses should even bother at all). 

What is Healthcare Equity? 

Healthcare equity describes the principle of ensuring everyone inside an organization receives fair access to quality healthcare services — regardless of their socioeconomic status. 

Pursuing healthcare equity means dismantling any systemic barriers that are biased against certain groups (e.g., race, ethnicity, gender, and location). 

While healthcare equity seems like it requires large-scale, macroeconomic solutions, small businesses can implement ground-level strategies that address potential disparities in the workplace. 

This begs the question, what's in it for small businesses?

Importance of Healthcare Equity for Small Businesses

Aside from the ethical and moral implications, below are the top reasons why small businesses should get involved in healthcare equity: 

1. Healthcare Equity as a Competitive Advantage

Attracting talent is one of the key benefits of offering quality employee healthcare. 

Data from Deloitte reveals that, in 2025, only 23% of healthcare executives cited equity as a priority. This will put your organization at an advantage over the majority of businesses should you provide equitable health benefits, especially when recruiting a diverse, skilled workforce. 

2. Build a Healthy and Motivated Work Culture

Health equity gives each and every employee peace of mind — no matter how unique or stigmatized their healthcare needs may be. 

It will not only improve your recruitment and retention efforts. With the right strategies, it will also help maintain an energized and productive work culture. 

3. Address Disparities in a Diverse Workplace

There's a good chance that you already have a health benefits program right now, but not everyone gets to enjoy their benefits at the same level. 

According to the WHO World Report on Social Determinants of Health Equity, black U.S. workers had their cognitive, mental, and even physical health negatively affected by perceived structural racism. Similar patterns have been observed with employees who feel victimized by perceived gender discrimination and ableism. 

Getting all-in with healthcare equity sends a positive message that you're company has everyone's back, ensuring they take full advantage of their coverage. 

How the OBBBA Can Compromise Healthcare Equity

For a lot of businesses, the signing of the OBBBA is a wake-up call to rethink their healthcare strategy. 

Here's why:

1. Potential Loss of Coverage Through Medicaid Spending Cuts

The OBBBA proposes a Medicaid spending cut of $863 billion to $1.02 trillion over 10 years. 

This poses a significant threat to healthcare equity, especially since minority groups are more likely to depend on Medicaid plans. 

According to the CBPP, people of color account for 46% of non-elderly citizens in the U.S. However, they make up 61% of non-elderly Medicaid planholders. 

With Medicaid funding being significantly downsized, small businesses need to focus on more accessible and equitable healthcare for minority employees. 

2. More Frequent Reverification Increases Administrative Burdens

Aside from the reduced budget, the OBBBA also applies stricter eligibility verification protocols. 

Before the new bill, Medicaid eligibility redetermination must be conducted at least once every 12 months. This window is substantially reduced to six months post-OBBBA. 

More frequent reverifications disproportionately affect minorities, including those hindered by the language barrier. Furthermore, the OBBBA also aims to eliminate subsidized care even for some legal immigrants, particularly refugees and any individual under a temporary protected status. 

3. Tighter Eligibility Requirements Can Further Healthcare Disparities

Lastly, the OBBBA tightens eligibility requirements for Medicaid and Affordable Care Act (ACA) Marketplace plans.

For one, Medicaid applicants are now required to complete at least 80 hours of qualifying activities as mandated by the OBBBA. This includes paid work, professional education or training, and volunteering. 

Again, this change is especially more challenging for minorities with unpredictable schedules, mobility issues, or even cognitive ailments that can prevent them from reaching the work requirement. 

What the OBBBA Does Good for Healthcare Equity

On the plus side, not everything in the OBBBA widens healthcare gaps across a diverse workforce. 

One particular change that can help minorities is the Rural Health Transformation Program, which is a $50 billion fund to be used for the enhancement of facilities and the accessibility of health services in rural areas. 

Individuals who rely on low-premium coverage, like Bronze and Catastrophic plans, are also now able to contribute to a Health Savings Account (HSA) — adding an extra layer of protection against future, qualifying medical expenses. 

Strategies to Improve Healthcare Equity Post-OBBBA

While the OBBBA comes with provisions that can potentially undermine equity, small businesses can do their part in ensuring everyone in the workforce gets the healthcare they deserve. 

If your small business is on board with this direction, here are some strategies to get you started:

1. Understand Workforce Needs

To build an effective healthcare strategy for your small business, you must first recognize that plan flexibility is just as important as affordability. 

Not every employee will have the exact same healthcare needs. And if your goal is to enforce healthcare equity, your first step is to communicate with employees and understand their pain points. 

This will bring you closer to developing a healthcare plan tailored to your business. Just remember to:

• Use inclusive language or translations when discussing employee benefits
• Ask individual employees for any accommodations that will help them accomplish their tasks more effectively
• Be transparent that your back-and-forths might affect their benefits

Must-read: Best Health Insurance for Small Business Owners

2. Invest in Employee Training and Education

The next step is to implement a more holistic approach when it comes to training and education pertaining to your company's healthcare structure. 

It's one thing to provide plan recommendations based on your employees' specific healthcare needs — it's another to teach them about the extent of their coverage and how they can take advantage. 

You can also host workshops and Q&A sessions to ensure they grasp the processes and steps in utilizing their benefits. Be sure to cover essential topics like submitting reimbursement requests, fulfilling reverification requirements, and using healthcare software solutions. 

3. Build a Culture of Acceptance for Stigmatized Healthcare

One of the deep-rooted issues affecting healthcare equity is the stigmatization of certain types of care, primarily services related to mental health. 

Data shows that 80% of workers avoid seeking mental healthcare services due to stigmatization. This prevents them from completing their daily tasks at full capacity and efficiency. 

That's why healthcare equity should include fostering a culture of acceptance for commonly stigmatized conditions. This requires a comprehensive communication strategy through either one-on-one consultations or seminars that underline the importance of self-care and general awareness. 

4. Transition to Flexible HRAs

Health Reimbursement Arrangements (HRAs) are a type of health benefit wherein the company reimburses employees for healthcare services and, in some cases, insurance premiums. 

Individual Coverage Health Reimbursement Arrangement (ICHRA), for example, incorporates a high degree of flexibility in terms of budget and coverage. With no minimum or maximum contribution limits, it enables small business employers to tailor employee benefits to a range of healthcare needs. 

In addition, ICHRA grants employees the freedom to choose their own individual health insurance plan — addressing disparities that impact healthcare equity, like unmet mental health needs. 

Building Equitable Healthcare with SimplyHRA

Another advantage of ICHRA is the availability of self-service solutions for small businesses. 

For example, SimplyHRA is a one-stop solution that consolidates everything you need to establish a robust ICHRA system without a third party. 

Here's an overview of its key features: 

• Set up plans in minutes — SimplyHRA allows you to create multiple ICHRA plans with different reimbursement allowances for employee classes. 
• Manage reimbursements — Employees can submit reimbursement requests directly through the app, which employers can approve or disapprove in a few clicks. 
• Employee onboarding — Easily onboard new employees while giving them customization tools, like out-of-pocket budget sliders and tailored plan recommendations. 
• AI Assistant — Both employers and employees can use the built-in AI assistant to request status updates, manage plans, or get answers to just about any question regarding ICHRA benefits. 

Finally, SimplyHRA features a user-friendly, intuitive interface that can be accessed through both mobile and desktop devices. This further closes the access gap for employees who can only rely on their phones, be it due to the nature of their work or current physical limitations (i.e., repetitive strain injuries). 

Conclusion

For most small businesses, pushing for equitable healthcare is a brand-new direction. 

The moral aspect of providing accessible healthcare for all individuals is just a piece of the bigger puzzle. With total healthcare equity, diverse startups and small businesses can bring the best out of their workforce. 

Use SimplyHRA to design an ICHRA plan that cultivates healthcare equity while shielding employees against the destabilizing OBBBA changes. 

Get started by booking a personal demo here!