Dive Brief:
- More Americans are paying cash in the emergency department while fewer rely on Medicaid, showing how coverage losses in the safety-net insurance program after the coronavirus pandemic are placing more direct financial pressure on low-income patients.
- In the second quarter this year, 7.6% of patients self-paid in the emergency department, up from 5.5% in early 2022, according to a sweeping analysis by Epic Research, a division of the electronic health record giant. At the same time, Medicaid encounters dropped the same amount, from 18.2% to 16.1%.
- The trend, which comes during a time of intense focus on healthcare affordability, is likely to continue as the U.S. absorbs additional cuts to Medicaid from the GOP’s reconciliation bill last summer.
Dive Insight:
Medicaid grew to a record size during the pandemic, covering some 1 in 4 Americans as states halted checks of enrollees’ eligibility in exchange for enhanced federal funding. That provision ended in the spring of 2023, allowing states to restart eligibility checks in a process known as unwinding or redeterminations. More than 25 million people lost Medicaid as a result.
Epic Research analyzed more than 550 million U.S. healthcare encounters to explore how coverage mix, or medical providers’ patients or revenue from different types of health insurance, shifted as a result of redeterminations.
It found that the self-pay share of encounters — often used as a proxy for uninsured patients — rose sharply in the ER from 2022 and 2026.
But self-pay patients increased across every setting studied, from 1.9% to 2.6% for inpatient admissions, 0.8% to 1.3% for births, and 1.8% to 1.9% for primary care.
Meanwhile, Medicaid encounters declined, from 13.2% to 11.7% for inpatient services, 23.1% to 21.5% for births and 11.4% to 10.3% for primary care, researchers found.
The study is notable for its scale. But it’s not the first to find that Medicaid coverage losses put low-income patients more directly on the hook for medical bills, especially in emergency situations — a concerning effect, given the U.S. is currently absorbing almost $1 trillion in cuts to Medicaid as a result of the GOP’s “Big Beautiful Bill” passed last July.
The law curtails financing mechanisms that allowed states to draw down more federal Medicaid dollars, enacts more frequent eligibility reviews and requires Medicaid adults in expansion states to log 80 hours of work, volunteering or education hours each month in order to stay enrolled, among other changes.
Almost 6 million people will lose Medicaid over the next decade as a result, according to the Congressional Budget Office.
The cuts come as healthcare feels increasingly out of reach for many Americans, as rising price tags for hospital care and drugs drive up insurance premiums and government policies that helped millions afford coverage are rolled back.
Healthcare consistently ranks in voters’ top-five concerns coming into the midterm elections. And costs top the list of voters’ healthcare priorities, according to recent polling by the KFF.
