Steps Health Systems Can Take Now to Protect Patients and Margins
Employer-sponsored health insurance, the backbone of U.S. healthcare coverage, is becoming unaffordable for many working families. Premiums are projected to rise by up to 9% in 2026, marking the steepest increase in 15 years. Meanwhile, insurers on Affordable Care Act (ACA) exchanges are hiking rates by an average of 4% to offset sicker risk pools. For the 24 million Americans enrolled in ACA marketplace coverage, those premiums could rise by more than 75% once enhanced federal subsidies expire. The Congressional Budget Office and KFF estimates as many as 4 million people could lose coverage in the first year alone.
The problems were already here before the One Big Beautiful Bill. Even before its passage, hospitals were already contending with rising uncompensated care rates of 8.2% and growing patient debt. Now, those pressures are being amplified.
As these pressures ripple through the system, the consequences are predictable and costly. When coverage lapses or out-of-pocket costs rise, patients delay or avoid care, increasing the likelihood of high-acuity admissions, uncompensated balances, and long-term declines in population health. For health systems already contending with thin margins, this insurance affordability crisis threatens to evolve into a full-scale revenue crisis.
From Coverage Gaps to Care Gaps
Hospitals and health systems are sounding the alarm as these trends are a direct threat to access and financial stability. As premiums rise, employers are shifting more costs onto employees through higher deductibles and coinsurance. Even insured patients are functionally underinsured, delaying care or prescriptions until conditions escalate. The result is a growing wave of high-acuity and often uncompensated hospital visits that leave healthcare providers absorbing the cost.
There is no sugarcoating it; the fragility of healthcare margins has reached a critical point. Financial distress is escalating. Healthcare provider organization bankruptcies reached 79 filings in 2023 and an additional 57 in 2024, surpassing the four-year average of 42. Across the sector, operating margins shrank by 100 to 300 basis points in mid-2025, coinciding with the intensification of patient debt and coverage churn. Without proactive strategies, the affordability crisis facing patients could become a severe financial crisis for hospitals.
Rising Premiums, Shrinking Coverage
Patients are paying more but getting less. Higher payroll deductions, deductibles, and coinsurance are forcing many to make painful tradeoffs. Routine care and prescriptions are postponed or skipped entirely, and when patients finally seek treatment, it’s often in emergency settings where costs and risks are higher. These patterns undermine population health and leave hospitals caught in a revenue trap, where more complex care is delivered to fewer covered patients.
For many health systems, the issue is unpredictability. Coverage lapses and re-enrollments lead to administrative waste and billing errors, which exacerbate financial pressure. When patients struggle to keep up with coverage, bills, or drug costs, they often fall out of the care ecosystem altogether.
Medicaid coverage is at risk. Beginning in 2026, new work requirements tied to the $1 trillion reduction in federal healthcare funding will mandate that beneficiaries work at least 80 hours per month, a threshold many may struggle to meet due to health challenges or limited employment opportunities. As a result, millions of Medicaid enrollees could lose coverage, and each state will be responsible for determining whether to allocate additional funding to help offset the federal reductions and protect access to care.
What Hospitals Can Control
Hospitals can’t reverse national insurance trends, but they can help mitigate the impact of downstream effects through practical, patient-centered strategies that protect access and stabilize margins.
- Identify Coverage and Recover Revenue
Many “self-pay” accounts occur because existing insurance coverage isn’t properly identified at the time of service — whether due to an oversight, technical error, or missing information from the patient. Automated coverage discovery using the latest technology can identify missed coverage so that “self-pay” patient cases are covered and can be refiled for reimbursement, converting what would have been write-offs into recoverable revenue. Integrating new real-time verification technology at scheduling or registration ensures cleaner claims, fewer delays, and improved visibility into payer eligibility. - Support Patients at Risk of Losing Coverage
With premium increases and the expiration of federal subsidies on 12/31/2025, many ACA enrollees may struggle to afford coverage and fall behind on payments. To prevent coverage loss, some companies now offer programs that help financially vulnerable patients pay their premiums and maintain care. Many patients who lose Medicaid or marketplace plans remain eligible but fail to re-enroll due to the complexity of the administrative process. Embedding financial advocacy into access workflows, through digital enrollment assistance, helps patients maintain continuous coverage. Hospitals benefit from fewer eligibility-related denials, fewer uninsured visits, and more stable reimbursement. - Offset High-Cost Therapies Through Philanthropic Aid
Drug affordability remains one of the biggest barriers to care continuity. Employer plans often incorporate steep pharmacy cost-sharing, while pressures on the 340B program and drug shortages continue to squeeze hospital margins. Many patients discontinue medications simply because they can’t afford them. Hospitals can step in by helping patients access manufacturer assistance programs and charitable foundations that help offset the high costs of therapies. These efforts reduce readmissions, prevent avoidable deterioration, and help protect pharmacy revenue streams, reinforcing trust with patients who might otherwise disengage from care. - Consumer-Grade Patient Financing for Out-of-Pocket
With out-of-pocket costs for families on high-deductible health plans reaching as high as $17,000 in 2026, patients are facing retail-sized bills without retail-quality financing options. It’s time to offer true consumer-grade patient financing, just like any other major purchase. A 0% interest, non-recourse, revolving line of credit is now available for patients, featuring a fixed rate, no penalty for early payment, and no requirement for a bank or credit card account. These programs can be used exclusively for care from participating healthcare providers, helping improve patient loyalty, engagement, and overall financial experience.
A System-Level Imperative
The convergence of premium inflation, subsidy volatility, and rising drug costs is reshaping how Americans engage with healthcare and how hospitals must respond. Financial access is now clinical access. When patients can’t afford care, they delay it; when hospitals can’t afford volatility, they reduce services or staff. Both sides lose.
By integrating early coverage discovery, enrollment support, and patient-friendly financing, health systems can transform this cycle into one of prevention rather than recovery. These steps won’t alter the macroeconomics of insurance, but they can improve the system for those caught in the middle.
From Volatility to Stability
The coming year will challenge traditional revenue cycle models. Shrinking reimbursements, policy uncertainty, and climbing insurance costs will continue to erode predictability across the healthcare landscape. However, for organizations willing to modernize their patient financial access processes, a path forward exists.
By pairing coverage discovery, enrollment support, affordability advocacy, and technology-enabled patient financing, health systems can turn insurance instability into an opportunity to reinforce community trust.
The organizations that thrive will be those that view every financial touchpoint as an opportunity to protect patients and margins, because the health of one depends on the health of the other.
