The Rising Number of Uninsured Patients Starts to Hit Hospitals
Wall Street Journal
July-31-2026
Suzanne Mercer and her husband Kip lost their Affordable Care Act plan this year because they couldn’t afford to pay more than $4,000 a month for the coverage. The couple, who manage a condominium complex in the Florida Keys, have stopped going to see their doctors.
Mercer, 59 years old, also hasn’t gotten a follow-up scan that a doctor ordered after a mammogram in December turned up a concerning spot. “It’s awful, you just cross your fingers,” she said. “I just don’t want to know right now, because I can’t do anything about it.”
Mercer is one of millions of Americans going without health insurance after the ending of federal subsidies that kept their ACA premium bills down. The loss is starting to bleed into the wider healthcare economy.
In recent earnings reports, hospital companies including Tenet Healthcare, Universal Health Services and Community Health Systems all cited growing costs from treating patients who didn’t have health coverage—in the case of HCA Healthcare, a $400 million drag on profit in the second quarter.
Intuitive Surgical, maker of da Vinci robot-assisted surgery machines, and lab operators Quest Diagnostics and Labcorp Holdings said these changes are affecting their businesses, too.
The number of people with ACA plans fell by about 2.6 million as of February, compared with a year earlier. The drop came as people dropped plans that in some cases started costing them twice as much after enhanced federal subsidies lapsed at the start of this year.
The ACA drop-offs varied by state. Some of the steepest were in Ohio, Oklahoma and Arizona, according to KFF, a health-research nonprofit. Insurers and actuaries expect enrollment will fall even more over the course of the year.
Nearly all of those letting their ACA plans go appear to be dropping insurance altogether, hospital company executives said, which is more than HCA and some others had expected.
“For us, obviously, it’s not a good thing,” said HCA Chief Executive Samuel Hazen in a call with analysts last week. “We still have to take care of these patients, and we do, and our people do a wonderful job, but it does put pressure on” the profit and loss statement.
The problems for hospitals are set to grow, with Medicaid adding federal work requirements next year. Already, Medicaid enrollment is ticking downward this year. The Congressional Budget Office projects a further 4.1 million people will lose coverage in 2027.
For hospitals, uninsured patients bring a financial double whammy. They often stop coming for elective procedures, hurting revenue. Yet the bigger blow hits when patients without coverage come to the emergency room. Hospitals are required to treat and stabilize them, but they typically don’t get paid. The hospitals can provide the care free of charge or at discounted rates through financial assistance, or try to charge patients. But often those patients can’t pay, leaving their bills to become bad debt that erodes hospital profits.
“We still provide care for all those that show up that need it,” said Ryan Cross, chief government affairs officer at FMOL Health, a 10-hospital Catholic nonprofit based in Baton Rouge, La. The system’s monthly bad-debt write-offs jumped about 23% in the second quarter of 2026, compared with the first, he said.
Banner Health, a 33-hospital system based in Arizona, has seen emergency-room visits grow 10% this year for patients who lost ACA coverage, and 13% for people who lost Medicaid. Among the conditions being treated are diabetes, congestive heart failure and chronic obstructive pulmonary disease.
CEO Amy Perry said Banner has seen uninsured patients stop coming in for preventive tests and regular checkups, and the nonprofit expects a rising need for serious emergency care later this year. “These things can be delayed for a certain amount of time,” she said, but eventually that catches up with people. “Unfortunately, we’re expecting a crisis at the end of this year.”
Hospitals are also experiencing a financial squeeze from ACA patients who tried to keep their monthly bills down by switching to cheaper plans with higher out-of-pocket charges, said Andrew Cooper, an analyst with Raymond James. Deductibles can be $6,500 or higher. For many patients, “that’s a big chunk of your annual income and not something that you’re able to pay,” he said.
July-31-2026
Suzanne Mercer and her husband Kip lost their Affordable Care Act plan this year because they couldn’t afford to pay more than $4,000 a month for the coverage. The couple, who manage a condominium complex in the Florida Keys, have stopped going to see their doctors.
Mercer, 59 years old, also hasn’t gotten a follow-up scan that a doctor ordered after a mammogram in December turned up a concerning spot. “It’s awful, you just cross your fingers,” she said. “I just don’t want to know right now, because I can’t do anything about it.”
Mercer is one of millions of Americans going without health insurance after the ending of federal subsidies that kept their ACA premium bills down. The loss is starting to bleed into the wider healthcare economy.
In recent earnings reports, hospital companies including Tenet Healthcare, Universal Health Services and Community Health Systems all cited growing costs from treating patients who didn’t have health coverage—in the case of HCA Healthcare, a $400 million drag on profit in the second quarter.
Intuitive Surgical, maker of da Vinci robot-assisted surgery machines, and lab operators Quest Diagnostics and Labcorp Holdings said these changes are affecting their businesses, too.
The number of people with ACA plans fell by about 2.6 million as of February, compared with a year earlier. The drop came as people dropped plans that in some cases started costing them twice as much after enhanced federal subsidies lapsed at the start of this year.
The ACA drop-offs varied by state. Some of the steepest were in Ohio, Oklahoma and Arizona, according to KFF, a health-research nonprofit. Insurers and actuaries expect enrollment will fall even more over the course of the year.
Nearly all of those letting their ACA plans go appear to be dropping insurance altogether, hospital company executives said, which is more than HCA and some others had expected.
“For us, obviously, it’s not a good thing,” said HCA Chief Executive Samuel Hazen in a call with analysts last week. “We still have to take care of these patients, and we do, and our people do a wonderful job, but it does put pressure on” the profit and loss statement.
The problems for hospitals are set to grow, with Medicaid adding federal work requirements next year. Already, Medicaid enrollment is ticking downward this year. The Congressional Budget Office projects a further 4.1 million people will lose coverage in 2027.
For hospitals, uninsured patients bring a financial double whammy. They often stop coming for elective procedures, hurting revenue. Yet the bigger blow hits when patients without coverage come to the emergency room. Hospitals are required to treat and stabilize them, but they typically don’t get paid. The hospitals can provide the care free of charge or at discounted rates through financial assistance, or try to charge patients. But often those patients can’t pay, leaving their bills to become bad debt that erodes hospital profits.
“We still provide care for all those that show up that need it,” said Ryan Cross, chief government affairs officer at FMOL Health, a 10-hospital Catholic nonprofit based in Baton Rouge, La. The system’s monthly bad-debt write-offs jumped about 23% in the second quarter of 2026, compared with the first, he said.
Banner Health, a 33-hospital system based in Arizona, has seen emergency-room visits grow 10% this year for patients who lost ACA coverage, and 13% for people who lost Medicaid. Among the conditions being treated are diabetes, congestive heart failure and chronic obstructive pulmonary disease.
CEO Amy Perry said Banner has seen uninsured patients stop coming in for preventive tests and regular checkups, and the nonprofit expects a rising need for serious emergency care later this year. “These things can be delayed for a certain amount of time,” she said, but eventually that catches up with people. “Unfortunately, we’re expecting a crisis at the end of this year.”
Hospitals are also experiencing a financial squeeze from ACA patients who tried to keep their monthly bills down by switching to cheaper plans with higher out-of-pocket charges, said Andrew Cooper, an analyst with Raymond James. Deductibles can be $6,500 or higher. For many patients, “that’s a big chunk of your annual income and not something that you’re able to pay,” he said.
