In recent years, Americans have seen a wave of policy changes that affect their daily lives. One of the most consequential is the rising number of uninsured people, which is raising concerns for hospitals nationwide and leaving many to wonder: what comes next?
What We Know
The One Big Beautiful Bill Act (OBBBA), signed by President Trump on July 4, 2025, extends much of the 2017 Tax Cuts and Jobs Act. Among its many changes are significant cuts to healthcare assistance. The Congressional Budget Office projects that the OBBBA will increase the number of uninsured Americans by 10 million in 2034, according to the American Hospital Association. The federal government is expected to see fiscal savings, but patients will bear the cost.
At the end of 2025, Congress also let the enhanced premium tax credits for Affordable Care Act marketplace plans expire. According to a KFF follow-up survey conducted in early 2026, 9% of people who had marketplace coverage in 2025 were uninsured, and most of those who switched plans or dropped coverage cited cost as the reason. Among enrollees who kept their coverage, 80% said their costs rose in 2026, and 51% said they were “a lot higher.”
The Risks for Uninsured Patients and Health Systems
Delayed Care
As routine care becomes more expensive, Americans are more likely to put off seeing a provider to limit costs. Even among marketplace enrollees who kept their coverage, KFF found that 49% worry about affording routine medical visits and 73% worry about affording emergency care or hospitalization. Hospital executives told the New York Times they are already seeing patients defer care such as joint replacements and cardiac testing. Delays in diagnosis and treatment compound over time and lead to hospitalizations for preventable complications.
Rising Medical Debt
According to a 2022 report from the Consumer Financial Protection Bureau, roughly 20% of U.S. households have medical bills on their credit reports, totaling $88 billion in outstanding debt. Without insurance, healthcare costs add up quickly. Patients who need care have little choice but to accept it, even when they cannot pay. As bills go unpaid, accounts are sent to collections, and aggressive collection efforts often follow.
The latest changes are already adding to this burden. SSM Health, a nonprofit hospital system, told the Times that its uninsured patients rose almost 21% and its bad debt rose almost 37% compared with last year. KFF also found that 55% of returning marketplace enrollees are cutting back, or plan to cut back, on food or basic household items to afford coverage and care. We expect medical debt to keep growing over the next decade.
Desperate Measures
Daily medications are crucial for managing chronic illness, and uninsured patients may face full retail prices at the pharmacy. As medication costs climb, some patients ration their doses or go without.
We have seen this most clearly among patients with diabetes. The cost itself is burdensome, but rationing insulin also raises the risk of diabetic ketoacidosis (DKA), a serious condition that can lead to lifelong complications, coma, or death.
Impact on ED Throughput
Our team has noticed a growing trend in ED throughput and length of stay. To handle increased volume, hospitals are moving patients through faster: Kaufman Hall reports that average length of stay fell 3% year over year in June, while discharges per day rose 5%. Teams from case managers to post-acute partners work to discharge patients efficiently, freeing beds for the next wave of ED patients. While this saves time for patients and staff, it can also lead to premature discharges, higher readmission rates, and continued strain from new admissions and more frequent handoffs.
Our clients are feeling it. As one hospital leader told us, “With the increase in ED visits seen since August, we need to rethink our resources, staff, and throughput processes. This is no longer a seasonal surge; it is reality.”
The Current State
Federal law requires hospitals to treat patients with emergency medical conditions regardless of insurance status or ability to pay, and our team expects Americans to keep turning to emergency care as their options narrow. In the Times report, HCA Healthcare, the nation’s largest for-profit hospital chain, said patients who lost marketplace coverage appear to be becoming uninsured nearly one for one, and it warned investors of roughly $1 billion in lower operating profit this year.
Some systems are responding by expanding partnerships with federally qualified health centers, patient navigation, and same-day access to keep newly uninsured patients from defaulting to the ED. As we continue to follow this trend, we believe getting patients care before it becomes an emergency is essential. Without it, the domino effect may bring greater health risks for patients, strained EDs and throughput, lower hospital revenues, clinic closures and service cuts, and higher prices for people with private insurance.
Sources:
Abelson, Reed. “After Obamacare Cuts, Hospitals Are Treating More Uninsured Patients.” The New York Times, July 30, 2026.
American Hospital Association. “CBO Projects OBBBA to Increase Uninsured by 10 Million, Federal Deficit by $3.4 Trillion.” AHA News, July 21, 2025.
Consumer Financial Protection Bureau. “CFPB Estimates $88 Billion in Medical Bills on Credit Reports.” March 1, 2022.
KFF. “Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees.” March 19, 2026.
Twenter, Paige. “Hospitals Treat Patients Faster as ED Demand, Unpaid Care Climb: Kaufman Hall.” Becker’s Hospital Review, August 18, 2026.
