U.S. health systems prepare for spike in uninsured patients amid cuts
ILLINOIS, UNITED STATES — United States health systems are bracing for a significant rise in uninsured patients as federal policy changes threaten to strip coverage from millions, prompting hospitals and clinics to reinforce safety-net strategies while facing mounting operational strain.
According to a report from the Becker’s Hospital Review, the Urban Institute and Congressional Budget Office estimated that 15 million people will lose their health insurance over the next decade as the enhanced Affordable Care Act (ACA) tax credits end and the One Big Beautiful Bill Act (OBBBA) will implement its Medicaid and Medicare rules.
Healthcare leaders warn that the tangible effects will be experienced most directly among those floating on the borderline, behind thin margins.
“Influxes of uninsured patients place significant strain on hospitals and health systems,” said Gena Lawday, BSN, RN, chief quality officer of UVA Community Health, part of Charlottesville, Va.-based UVA Health.
She identified two issues, which included chronic disease management gaps and increased emergency department usage for nonemergency situations, as reasons hospitals would face capacity challenges without proper advance planning.
Community partnerships as frontline defense
To increase their operational capacity, numerous systems expand their contractual relationships with community organizations and federally qualified health centers (FQHCs) to establish patient connections to preventive healthcare services.
“We’ve been building a lot of relationships, and we’re only helping to strengthen those over the coming months,” said Baligh Yehia, MD, president of Philadelphia-based Jefferson Health.
Jefferson works closely with FQHCs across Pennsylvania, New Jersey, and Delaware, where physicians from the system rotate through clinics and help maintain continuity of care. Dr. Yehia said the centers are a critical safety net for patients with chronic conditions who risk losing coverage.
Duke Health has taken a similar approach in North Carolina. The Durham-based system partners with Lincoln Community Health Center, an FQHC serving about 40,000 patients annually, providing both financial support and clinical staffing.
“It’s hard to talk to people about advanced care when they’re hungry or homeless,” said Alice Cooper, RN, medical director for access and associate chief medical officer for the Duke Health Integrated Practice, underscoring the need to address social determinants of health alongside medical care.
Insurance navigation and flexible access to care
Beyond care delivery, systems are investing in insurance navigation and access flexibility to prevent avoidable coverage losses.
Changes under OBBBA will require Medicaid beneficiaries to verify eligibility every six months beginning in 2027, increasing the risk of administrative lapses.
“We’re investing in navigation, in people and in technology to make sure that we’re keeping track of folks and of their eligibility,” Dr. Yehia said.
Duke’s “Duke Today” program, which offers same-day or next-day appointments, is one example of adapting access models for patients who cannot afford to miss work. In 2025, the system offered 3,395 such appointments.
As coverage gaps widen, leaders say many strategies echo pre-ACA approaches.
“It’s a little bit of ‘Back to the Future’ here,” Dr. Yehia said. “We’re dusting off that playbook from before that we can now leverage.”
