In Q2 2025, Advisory Board interviewed over 150 U.S. healthcare executives preceding the passage of the One Big Beautiful Bill Act (OBBBA) to understand how they are navigating a landscape defined by policy uncertainty, financial strain, and operational complexity. Leaders consistently identified three top priorities: improving operational efficiency through technology and streamlined workflows, balancing shortterm financial survival with long-term investment, and reassessing strategic direction to align services with mission and sustainability. OBBBA has added complexity to an already strained system, prompting executives to rethink how they plan and advocate. To drive meaningful reform, leaders emphasized the need to move beyond defensive strategies, track the realworld impact of policy changes, and collaborate across sectors to build a more resilient and equitable healthcare system.