Darshan Kulkarni and Edye Edens examine the far-reaching implications of the newly passed “Big Beautiful Bill”—a sweeping piece of legislation tied to the Trump administration’s political agenda. While the bill itself does not directly reference clinical research, Darshan and Edye highlight how its provisions—particularly the reduction in Medicare and Medicaid funding—could have serious downstream effects on clinical trial access and site viability.

Edye raises concerns that the legislation may lead to the closure of small physician practices and rural health centers that rely heavily on government reimbursement to operate. These closures could reduce the number of viable clinical trial sites and limit opportunities for underserved populations to participate in research. Additionally, the loss of Medicare coverage for patients may hinder routine care billing within trials, further discouraging sites from participation—especially smaller ones already burdened with administrative complexity and financial strain.

Darshan adds that while academic research institutions often navigate reimbursement issues with dedicated billing teams, many private sites, particularly those with low trial volume, rely entirely on sponsors to cover costs and avoid direct reimbursement processes. He also raises the possibility that trial sites could inadvertently become the de facto providers of clinical care in underserved areas—especially if other care options disappear due to budget cuts.

The conversation evolves into a broader discussion on how health system strain may lead to increased use of telemedicine, as well as the growing reliance on nurse practitioners (NPs) and physician assistants (PAs) to fill care gaps. However, legal limitations—such as whether a PA can serve as a Principal Investigator (PI) if they are not legally allowed to make independent medical judgments—could complicate this trend. The episode closes with a teaser for a future discussion on that very question.

Viewers are encouraged to consider not just the immediate financial and political implications of the bill, but also how changes in access, coverage, and staffing may reshape the clinical research ecosystem in the years ahead.

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