The OBBBA calculator starts with a baseline year and then projects the next ten years by layering policy- and market-sensitive adjustments on top of that starting point. Revenue begins at R0 and is decomposed by payer mix: Medicaid (Pmedicaid), Medicare (Pmedicare), ACA-subsidized patients (Paca), and private/other (Pprivate). The tool applies two distinct headwinds to the Medicaid slice, a reimbursement cut (δmedicaid) and a volume loss due to work-requirement attrition (εenroll), which together reduce both the rate and units on that portion of revenue. ACA volume faces its own shrinkage parameter (γaca). A rural support inflow (Frural) then offsets part of the payer pressure when eligibility applies. The entire revenue base grows with general inflation (i) across the horizon (T), so you see the push-pull between policy shocks and nominal growth. Costs start from C0 and scale each year for two forces: routine price growth (again, i) and an explicit environmental-health cost increase (ηenv), which captures climate- and exposure-related spending pressures. Pre-tax profit equals (Revenue minus Costs), and net profit applies a tax effect shaped by the tax-benefit input (τtax). The model finally discounts the stream of net profits at a rate (r) to compute NPV, which gives a single, present-day value for the entire plan. For this example, the first projected year (2026) lands a touch below the $500M baseline on revenue ($495.2M), reflecting Medicaid and ACA headwinds before inflation, and the rural inflow can fully lift the trajectory. From there, both revenue and costs rise, but the added rural dollars, payer segments less affected, and routine price growth keep pre-tax profit moving upward in most years. You can see a modest wobble in 2028, where revenue dips while costs continue to climb, a reminder that small changes in payer volume or rate assumptions can significantly impact margin in a given year. Even with those pressures, net profit trends from approximately $30.8M to $33.7M by 2035, and the discounted value of the whole decade sums to an NPV of nearly $206.3M. Use the sliders and inputs to run “what-ifs”: raise (εenroll) to see how deeper Medicaid attrition compresses margins, drop (ηenv) to test savings from prevention and mitigation, toggle (Frural) to gauge dependence on external funds, or adjust (r) to reflect a tighter or looser capital market. Those sensitivity sweeps will reveal which levers dominate value creation in your setting and where management attention will yield the most protection against policy shocks.