As a result, other hospitals in the area saw higher volumes of patients and more uninsured patients; one hospital’s share of uninsured patients more than tripled, from about 13% to nearly 45%, a study found. This redistribution of sick people led to severe overcrowding in other hospitals and higher costs for insured patients.
She’s scrambling to find funding from elsewhere, including from a new 5% sales tax recently passed in Los Angeles County to fund local health services, including safety net hospitals like hers. She’s determined to keep MLK Community Hospital open, but she knows other hospitals won’t be successful in doing so. One analysis found that more than 300 rural hospitals are at risk of closing because of H.R. 1.
Or they close altogether. “There will be hospitals that will likely close as a result of the financial distress, and the patients that were served by those hospitals will need to go somewhere else,” she says. “They will go to hospitals in other neighborhoods, and those emergency departments will become more crowded, and those hospitals will become more crowded.”
The U.S. is facing its most serious health-insurance crisis since the passage of the Affordable Care Act in 2010. It’s not just that H.R. 1 is projected to make more people lose Medicaid coverage; Congress decided not to renew subsidies for the Affordable Care Act in 2026, meaning that thousands of families are seeing the cost of insurance skyrocket and are deciding to drop insurance coverage rather than pay hundreds or thousands of dollars a month for care. All told, the Congressional Budget Office expects 16 million more people to be uninsured by 2034.
“There’s a ripple effect that hits the uninsured and newly uninsured and underinsured particularly hard,” says Anthony Wright, executive director of Families USA, a national consumer health advocacy group. “But it ripples through families and communities and the health system we all rely on.”
How hospitals absorb the costs
Safety net hospitals are most in danger of seeing their finances erode quickly. That’s because they are, by definition, non-profit hospitals that provide care to people regardless of their insurance status or ability to pay. America’s Essential Hospitals, an association for safety net hospitals, said in an interview that among its 400 members, three-quarters of the patients they serve are uninsured or on Medicare or Medicaid. Already, these hospitals are losing money every year, says Jennifer DeCubellis, president and CEO of America’s Essential Hospitals. This is likely to get worse as more people delay care and then end up in emergency rooms, where their care is going to be more expensive, she says. “We're going to see longer wait times in emergency departments,” she says, “and what we've already started seeing, even before the One Big Beautiful Bill, is the loss of services in local communities.”
When hospitals have more uninsured patients, they have to absorb the costs of providing that care. They then often pass those costs onto insured patients by charging insurers more for services, studies have found.
What happens when people lose insurance
Rena Healy, 30, is one uninsured patient who is doing everything she can to avoid turning up in an emergency room, even though she has a heart condition that requires her to be on $1,000-a-month medicine she can’t afford. She was on Medicaid in Indiana, but recently moved to Tennessee to be near her fiance. Tennessee, unlike Indiana, has not expanded Medicaid, and Healy suddenly found herself unable to qualify for health insurance.
She’s been applying for more than 100 jobs a week but hasn’t found anything yet, she says, and meanwhile is running to the end of her medication supply from when she was in Indiana. For now, Healy is leaning on public clinics for appointments and trying to avoid going to the ER, even though she knows that the monitor implanted in her sternum could show her heart rate going up to 250 bpm, which would necessitate an ER visit. “I sympathize with people who don’t want to go to the ER or take an ambulance even if they’re dying,” she says. “They don’t want to cash-strap their family.”
Avoiding health care for financial reasons ends up being more expensive in the long run; when people skip preventative care, they end up sicker by the time they go to the doctor, often in an ER.
As a result, he predicts, people going to the emergency room for anything will see longer wait times, especially as health systems close clinics and hospitals that are losing money.
Hospitals won’t just be more crowded. They’ll also be forced to cut back on preventative services and those that help keep people out of the emergency room, says David Perlstein, the president and CEO of SBH Health System. For instance, SBH, which is located in the Bronx, has a violence interrupter program for teens and a boxing program that makes communities safer for young people.
It’s something that Batchlor worries about, too. Only about 3-5% of patients at MLK Community Hospital have private insurance, she says, so it can’t just raise rates on privately insured patients to make up for a surge in uninsured. The hospital has won accolades for its diabetes management program, which is bringing down the need for amputations, and for its wound care program, which has helped people stay out of the emergency room. But she’s worried about the health system’s ability to be able to provide that kind of preventative care.
“We'll all be worse off for having let people get sicker and end up needing more expensive care—ending up with amputations, ending up on chronic dialysis,” she says. “None of that is really what we should be doing as a society. It's not financially effective, and it's not humane.”
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