On July 4, 2025, President Trump signed into law a reconciliation bill that enacts significant changes to federal health care programs and tax policy. The One Big Beautiful Bill Act (H.R. 1) passed the U.S. Senate on July 1 with Vice President J.D. Vance casting the tie-breaking vote before being passed by the U.S. House of Representatives on July 3 by a vote of 218-214. The bill directs a reduction of nearly $1 trillion in federal Medicaid spending over ten years, primarily achieved through the implementation of work requirements and reforms to how states finance their cost-sharing mechanisms. The legislation creates a rural stabilization fund, the Rural Health Transformation Program, intended to offset the initial impact of Medicaid reforms on rural hospitals and community health centers. 
 
Notably, the legislation eliminates the Grad PLUS loan program and caps graduate student borrowing at $20,500 annually, with a $100,000 lifetime limit. Professional students, including dental students, face a $50,000 annual cap and a $200,000 lifetime cap. The legislation does not include the previously proposed exclusion of medical and dental internships and residency programs from qualifying repayment for new borrowers.
 
The legislation preserves full access to the pass-through entity tax (PTET) deduction for all professions, including specified service trades or businesses (SSTBs) such as small business dental practices. On June 9, 2025, the AGD signed onto a coalition letter urging Senate leadership to protect PTET deductibility. The AGD also published a Call to Action urging its membership to contact their U.S. Senators and tell them to protect the PTET deduction, which had been cut in the bill passed by the House of Representatives.  Thank you to everyone who submitted letters to your U.S.  Senators.  Your advocacy was consequential. 
 
The full reconciliation text can be found here.
 
Impact on General Dentistry: The elimination of the Grad PLUS loan program and new borrowing caps could significantly limit access and affordability for dental education, particularly for students from low- and middle-income backgrounds. Additionally, Medicaid cuts and administrative changes may reduce access to dental care for vulnerable populations. The preservation of full PTET deductibility is a positive outcome for dental practice owners.