Brace Yourself: The “Beautiful Bill” That Could Break Open Enrollment

Let’s be honest: Open enrollment has always been tough. Now imagine throwing into the mix a 900-page federal funding overhaul that touches everything from Medicaid eligibility to HSAs to mental health access. 

Welcome to fall 2025. 

Nicknamed the “One Big Beautiful Bill” (OBBB), this sweeping legislation is already reshaping how employees interact with their workplace benefits, whether they’re aware this is happening or not. And that lack of awareness is the problem — for employees and for HR and benefits leaders. 

Without crystal-clear communication, smarter tools, and a profound rethinking of our enrollment playbooks, this fall could break even the most seasoned HR and benefit teams. 

This article looks at what’s heading your way and how you can turn this disruption into a chance to lead. 

A Perfect Storm of Confusion (and Opportunity) 

At its core, OBBB consolidates federal spending and reduces funding for many safety net programs, including Medicaid, CHIP, and public health resources. 

What about for employers? For them, this shift means: 

• A flood of new dependent enrollments as public coverage dries up. 
   

• More employees defaulting to high-deductible plans out of financial necessity. 
   

• Rising interest in voluntary benefits like critical illness and hospital indemnity coverage. 
   

• HSAs and FSAs being used more like emergency funds than budgeting tools. 
   

• A mental health cliff, with shrinking community support and surging demand for digital care options. 

• A ripple effect from new Medicaid payroll verification rules. Many full-time contingent workers (freelancers, gig workers, or full-time temps) don’t receive regular paystubs, as most full-time employees do. This makes it harder for them to verify ongoing Medicaid eligibility, which the new rules require. When coverage is lost, these employees could default to employer-sponsored plans — theirs or a spouse’s — creating unexpected enrollment surges. 

And the twist? Many employees are unaware that these changes are coming and don’t know how much the new rules will impact their health, finances, or family coverage choices this fall. 

5 Ways OBBB Will Reshape Enrollment Behavior 

So what does all of this policy noise actually mean for your employees and you? It means enrollment behaviors are about to shift fast, and not always in ways that make sense on the surface. 

From last-minute dependent adds to high-deductible sticker shock, the downstream effects of the OBBB will show up in how your people choose (or avoid) coverage this fall. Here are five key changes to expect and what they’ll demand from HR teams trying to keep up. 

1. Dependent Enrollment Is About to Skyrocket 

Stricter Medicaid and CHIP income rules are set to push millions (yes, millions) of people off of public programs. As a result, employer-sponsored plans will become the fallback for spouses and children who suddenly find themselves uninsured. 

HR Red Flag: Expect heavier open enrollment traffic, more questions about family coverage costs, and a potential strain on risk pools as families with complex health needs join your plan. 

How to Prepare: Preempt confusion with plain-language breakdowns of dependent eligibility. Use decision-support tools that walk employees through different household scenarios. 

2. Employees Will Flock to HDHPs and Delay Care 

Inflation is real. Faced with rising premiums, employees are trading richer plans for paycheck relief. According to Willis Towers Watson, 41% of individuals chose HDHPs last year primarily to lower their costs. 

The consequence? 

• More ER visits for preventable issues. 

• Less proactive care. 

• A spike in stress-driven utilization patterns. 

HR Red Flag: Employees may appear engaged by selecting “cheaper” plans, but later face unanticipated costs. Expect increased reactive claims, higher absenteeism from untreated conditions, and dissatisfaction when care becomes unaffordable post-enrollment. 

How to Prepare: Reinforce financial literacy. Explain to employees when and how to use urgent care, virtual consults, and HSAs to avoid out-of-pocket shocks later. 

3. Voluntary Benefits Are the New Safety Net 

As medical debt continues to contribute to more than two-thirds of U.S. personal bankruptcies, and with over 40% of adults currently carrying debt from medical or dental care, employees are increasingly looking for financial protection benefits. Critical illness, hospital indemnity, and disability options are no longer fringe add-ons; they’re perceived as crucial shields. 

In fact, Gallagher’s 2023 voluntary benefits benchmarking study already showed a 36% increase in employer interest in critical illness policies and a 24% rise in hospital indemnity coverage. In a separate survey this year, from Voya Financial, 83% of employees said they'd be likelier more likely to work for or stay with an organization that offers these protections. 

HR Red Flag: Employees often overlook or misunderstand these options without strong framing. Low visibility now could mean missed protection later and more pressure on HR to explain “what’s not covered” when financial stress peaks mid-year. 

How to prepare: Reframe these benefits as tools to protect paychecks and savings. Interactive cost scenarios work better than static PDFs. 

4. HSAs and FSAs Are Getting Rebranded — by Your Employees 

The data is in: employees are treating HSAs like rainy-day funds. In 2024 alone, they poured $56 billion into HSAs — a double-digit increase — while also pulling out more than ever before. 

That means they’re starting to see these accounts as true financial resilience tools. Are you messaging them that way? 

HR Red Flag: If your communications still focus on “planned medical expenses,” you’ll miss the mindset shift. Employees may underfund accounts early, then panic when emergencies hit. Expect more transactional help-desk traffic and frustration over missed savings opportunities. 

How to Prepare: Educate employees on both short- and long-term value. And if you can, offer an employer match to encourage early contributions. 

5. Mental Health Demand Is Spiking (and Community Care Is Shrinking) 

Community-based mental health programs are shrinking under the new federal budget. Digital care, from app-based therapy to telepsychiatry, is now the go-to solution, especially for younger workers. 

OBBB also expands reimbursement rules for digital health, giving employers a more straightforward path to claim telehealth coverage. 

HR Red Flag: Shrinking public resources mean employees are turning to employer offerings by default, ready or not. If your mental health tools are outdated, underpromoted, or hard to access, you risk underutilization, rising burnout, and quiet quitting. 

How to Prepare: Ensure your EAP includes modern, on-demand options. Evaluate partnerships with mental health platforms now — not after burnout spikes. 

The Bigger Picture: What HR Needs to Do Now 

This isn’t just an open enrollment issue. It’s a workplace well-being issue, an equity issue, and a trust issue. 

And it’s your moment to step up.  

Here’s how you lead: 

• Communicate early and often. 
  Your people are about to lose Medicaid or see their spouse children kicked off CHIP. Don’t let them find out the hard way. 
   

• Upgrade your decision-support stack. 
  Static PDFs won’t cut it. Invest in AI-driven plan comparisons, scenario calculators, and personalized guidance. 
   

• Position benefits as stability tools. 
  From HSAs to mental health apps, show how your offerings address uncertainty and not just medical need. 
   

• Train managers as navigators. 
  They’re your first line of defense against confusion. Give them the scripts and tools to triage and direct. 

Final Word: Chaos Is Inevitable. Clarity Is Optional. 

The “One Big Beautiful Bill Act” may be D.C.-approved, but its impact will be felt in every HR inbox and enrollment portal this fall. Confusion is coming. But so is the opportunity to lead with empathy, insight, and strategy. 

The HR teams that break through the noise with clear messaging, smart tech, and real support won’t just survive open enrollment. They’ll earn trust that lasts far beyond it.