Dr. Elaine Batchlor, CEO of MLK Community Hospital in Los Angeles, already knows what will happen if her hospital closes. All she has to do is remember King Drew, a similar safety net hospital that provided care to a large share of low-income patients in the same neighborhood, that closed in 2007 because of safety and quality problems. The low-income neighborhoods in South Los Angeles were without a hospital for almost a decade.
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.
Now, Batchlor and many other hospital administrators are bracing for this dynamic once again as cuts from H.R. 1, also known as the One Big Beautiful Bill Act, ripple across the U.S. health care system. H.R. 1 makes it more difficult for people to stay on Medicaidby introducing work requirements and by demanding that people re-confirm their income and address every six months, rather than every year. It also reduces the amount of state funding hospitals receive through the Medicaid program. Batchlor estimates that her hospital will lose between $80-$100 million a year because of H.R. 1.
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.
What Batchlor wants people to know is that an increase in uninsured people doesn’t just affect the people losing insurance. It affects everyone. More uninsured people means more of a financial burden on hospitals—particularly hospitals like hers, which are located in low-income neighborhoods and which will incur higher costs treating everyone who shows up in the emergency room because they’ll see more uninsured patients. When hospitals face financial distress, they cut back on services: often ob-gyn and preventative care.
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.”
What’s more, people with insurance are likely to see their costs rise as the number of uninsured Americans spikes. Hospitals and doctors must charge more as they provide more non-reimbursed care. A September 2 report by Marsh, the consulting firm formerly known as Mercer, estimates that the cost of health insurance plans to employers will increase by 11% in 2027—the biggest jump in decades—and that many employers will pass those costs on to their workers. “Lower government funding and reimbursements in public health programs are also driving higher charges or care in employer plans,” the report found.
Why the health-insurance landscape is changing so quickly
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 renewsubsidies 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.
People who will not have health insurance may forgo primary care, checkups, and other preventative measures, and could be saddled with hundreds of thousands of dollars in bills if they get a serious illness. But it’s not just bad news for them—the insurance crisis threatens the finances and care of everyone, even if they have private insurance plans and are sure they won’t lose coverage, experts say. Everyone is likely to face longer wait times, fewer services, and higher costs as hospitals and medical systems sag under the weight of more uninsured. And as the example of MLK Community Hospital shows, they may also be paying higher taxes on products that aren’t even health related to help fund care for the uninsured.
“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.”
Some hospitals are already closing. Select Specialty Hospital—Tucson East recently announced its imminent closure, though a spokesperson did not confirm it was because of H.R. 1. Others are already making tough choices about what services to continue. One Las Vegas hospital said in August that because of increased demand for its emergency room services, it was closing its maternity and NICU services by the end of September.
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.”
For-profit hospitals are also seeing a surge in uninsured patients stressing their finances. Executives at HCA Healthcare, the nation’s largest for-profit hospital chain, said on an earnings call in July that individuals who had lost coverage because ACA subsidies disappeared were now showing up at hospitals uninsured. Other for-profit hospitals are also reporting large increases of uninsured patients seeking care.
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.
“One of the reasons our premiums have been increasing for employee-sponsored health care is that hospitals that do charity care get a tax benefit, but they also add the cost of their unfunded care to the prices they charge to employee-sponsored health care,” says Heidi Russell, director of the Center for Health Policy at the Baker Institute at Rice University.
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.
Her career as a video game developer doesn’t make her enough money to pay the $500 a month that a plan on the Affordable Care Act marketplace would cost, she says. So she’s looking for a job that provides health insurance, including as a cashier or certified nursing assistant, even though her heart condition means she’s not supposed to do physical work.
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.”
Healy is one example of what can happen when people lose insurance; unable to get preventative care, they can’t manage their symptoms as effectively. One study of the Medicaid expansion in the South found that when more people gained health insurance, health declines in low-income adults slowed down because they were able to seek preventative care.
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.
“It’s $2,500 to do a colonoscopy, but it’s $130,000 to treat someone for Stage IV colon cancer,” says Dr. Erik Mikaitis, CEO of Cook County Health, one of the largest public health systems in the nation. Already, Cook County Health—which runs two hospitals and a dozen community health centers in Chicago, while also providing health care to the Cook County Jail—has seen an increase from 19% of patients being uninsured to 25%, just since January. Mikaitis is worried that instead of managing patients’ diabetes and high blood pressure, doctors will be seeing more patients with strokes and heart attacks in the emergency department.
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.
“This isn’t just a Medicaid problem,” he says. “There’s going to be this cascade of failure in terms of access. You’re going to see people in the hallways waiting to be seen.”
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.
“As we erode our margin, we may have to pull back services at some point,” he says. “We’re not doing it yet. But if this continues and there is no change, we’re going to have to make some very difficult decisions in the near future.”
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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