ACA subsidy lapse could spike ER visits, uninsured patients

ILLINOIS, UNITED STATES — Hospitals and health systems across the United States are preparing for higher emergency room volumes and increased uncompensated care after enhanced Affordable Care Act (ACA) premium tax credits expired on December 31, 2025, leaving millions of Americans facing difficult choices between medical care and daily necessities. 

According to a Becker’s Hospital Review report, with congressional negotiations to revive the subsidies still uncertain, healthcare providers are bracing for what could be a challenging 2026.

ERs prepare for post‑subsidy coverage losses

Nearly 93% of the 24.3 million Americans enrolled in ACA marketplace plans in 2025 relied on enhanced subsidies, according to the Centers for Medicare & Medicaid Services. 

The Urban Institute estimates that up to 4.8 million people could lose coverage without a legislative extension.

“Americans continue to say affordable coverage matters. Families want stability and they want to know they can access care when they need it,” Ascension President and CEO Eduardo Conrado said in a January 9 statement shared with Becker’s. 

“More than 20 million people are facing higher premiums or the loss of coverage altogether. For many of our patients, these tax credits are the difference between having insurance and delaying or going without care. Their expiration forces impossible choices between medical care and everyday necessities and increases the risk of medical debt,” Conrado explained.

Hospital leaders warn the policy change will ripple across health systems, creating longer delays and wait times, particularly in already overburdened emergency departments. 

“We’re currently assuming the subsidies for the exchanges will go away, and that’s likely to increase uncompensated care,” Kyle Benoit, executive vice president and COO of Dover, Del.-based Bayhealth, said on the Becker’s Healthcare Podcast. 

“As a not-for-profit, community-based hospital, that will probably mean more activity in our ER. We have to care for these patients when they walk through our doors,” Benoit added.

Bayhealth is taking proactive measures, including expanding fast-track emergency department areas and streamlining inpatient flow, but Benoit emphasized that waiting for political clarity is not an option. 

“We have to stop hoping challenges will go away and instead focus on real opportunities to reduce the cost of care while staying accessible to our patients,” he said.

Economic shock to states and health jobs

The subsidy lapse could also hit state economies and healthcare employment. 

A Commonwealth Fund analysis projected a $57 billion drop in national economic output, a $34 billion decline in state GDPs, and the loss of 286,000 jobs in 2026, including 130,000 healthcare positions. 

States most affected include Texas, Florida, Georgia, Mississippi, South Carolina, and Tennessee.

“With the tax credits expired, millions of hardworking Americans are now priced out of health coverage and need Congress to act,” Charlene MacDonald, president and CEO of the Federation of American Hospitals, said in a statement shared with Becker’s. 

“Real relief requires a bipartisan solution that extends the tax credits, lowers Americans’ health care costs, and can be signed into law,” MacDonald added.

Conrado also called on lawmakers to act quickly. 

“This is not about politics. It is about people. Extending these tax credits would help families keep coverage and ensure care remains available for the people who depend on it,” he said. 

Hospitals assert that taking swift measures is absolutely necessary and critical to stopping the widening of access gaps, overcrowding in the emergency departments, and putting additional pressure on already-burned-out healthcare safety nets.

The pressure on U.S. healthcare systems is already evident. Various healthcare facilities, such as hospitals, clinics, and community health centers, are trying to cope with the situation by adjusting staff levels, expanding triage areas, and reallocating resources to areas with increased patient volume and to address care gaps not being compensated.

Financial and logistical burdens are expected to create a ripple effect throughout the healthcare system, impacting areas such as emergency room length of stay and primary care accessibility; therefore, the immediate need for coordinated action by both politicians and health system managers will be highlighted.