Clinical leaders across the country are well aware of the challenges individuals face when they are uninsured: delays in care and worsening health conditions, which ultimately lead to more complex and costly treatment.
The prospect of a widening pool of uninsured is increasingly an imminent reality. Millions of people are projected to lose insurance coverage in the coming years following the expiration of enhanced ACA tax credits and upcoming cuts to Medicaid under the One Big Beautiful Bill Act. Nearly 15 million people could become uninsured over the next decade: 5 million without an extension of the subsidies, and another 10 million under OBBBA’s Medicare and Medicaid provisions, according to estimates from the Urban Institute and Congressional Budget Office.
“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. “Gaps in chronic disease management, limited access to primary and specialty care, and reliance on the emergency department as a first point of contact for non-emergent conditions all contribute to overwhelming already vulnerable institutions. Hospitals and health systems can better prepare for this challenge through early intervention, strong community engagement and a focus on operational efficiency.”
To stay ahead of these challenges, health systems are prioritizing efforts to address social determinants of health, expand care in community settings and help patients navigate administrative hurdles to avoid lapses in coverage.
Becker’s spoke to three clinical leaders about how their systems are preparing to support uninsured patients and prevent deteriorating health that could result in emergency department visits.
Community partnerships and local care delivery
One consistent theme stood out in every leader’s remarks: Community partnerships are central to keeping patients connected to preventive care and avoiding further strain on already crowded emergency departments.
“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.
The 33-hospital system works closely with a network of federally qualified health centers across Pennsylvania, New Jersey and Delaware. Also known as community health centers, FQHCs provide primary care services and receive federal funding through grants and enhanced reimbursement from Medicare and Medicaid. This funding structure allows them to offer discounted care on a sliding scale, or in some cases, at no cost to patients based on income.
A number of Jefferson physicians serve as medical directors at these community clinics, and specialists from the system also rotate through the sites to ensure continuity of care.
Dr. Yehia said these centers will be a critical safety net to ensure vulnerable patients, particularly those with chronic conditions, continue to receive routine care.
For years, Durham, N.C.-based Duke Health has also partnered with local clinics to expand access to care for low-income and uninsured individuals, according to Alice Cooper, RN, medical director for access and associate chief medical officer for the Duke Health Integrated Practice. One of its most prominent collaborations is with Lincoln Community Health Center, a large FQHC serving about 40,000 patients annually. Duke supports the center financially and provides clinical staffing, Ms. Cooper said.
Strengthening ties with community organizations isn’t just about expanding access to medical care; it’s about connecting patients to resources that help meet basic needs so they’re in a position to stay on top of their care in the first place, leaders said.
“It’s hard to talk to people about advanced care when they’re hungry or homeless, or their basic needs have not been met in a way that they would really care too much about prevention because their fundamental needs have not yet been addressed,” Ms. Cooper said.
With more patients at risk of losing coverage, leaders say this moment has reiterated a longstanding but increasingly urgent commitment to address the social factors that affect a person’s health. When patients must pay out of pocket for care, it often means pulling from limited budgets meant for food, housing or education. Recognizing that, health systems are leaning more heavily into partnerships and programs that help fill these gaps.
At Duke, much of that work is led by the system’s community health office, which is overseen by Ian Brown, who serves as the system’s chief community health and social impact officer. A familiar face in Durham’s neighborhoods, Ms. Cooper said Mr. Brown builds trust by routinely showing up in churches and other community spaces. There, he connects residents to resources ranging from local vaccine programs to food assistance.
Dr. Yehia said Jefferson has also ramped up its work in this area, forging new partnerships with food pantries and pharmacies to help ensure patients can afford medications and don’t go without necessities.
Similarly, Ms. Lawday said UVA Health has invested heavily in community outreach and prevention efforts. The system routinely conducts community-based screenings for high blood pressure and other chronic conditions, hosts chronic disease management classes and offers free immunization clinics. UVA has also taken steps to improve emergency department efficiency amid rising demand, implementing upright care processes designed to expedite treatment for patients with lower-acuity needs.
Many systems have long been engaged in these types of efforts, but leaders said the current environment has brought a new level of visibility and urgency to the work. The shift has prompted a sharper strategic focus, with greater resources dedicated to forging new partnerships.
Navigation support and flexible access
Health systems’ roles are expanding beyond care delivery, with some moving further upstream to prevent coverage loss and ensure patients can access care without disruption.
In addition to expanding community partnerships, Jefferson is focused on preventing coverage loss by identifying patients at risk of losing Medicaid and offering logistical support before lapses occur. A key concern stems from changes included under OBBBA, which introduces more frequent Medicaid eligibility redeterminations. The change, set to take effect in 2027, will require individuals to verify their eligibility every six months rather than once a year. Dr. Yehia said this could result in people losing coverage not because they’re ineligible, but because they miss paperwork deadlines or aren’t fully aware of the requirements.
In Pennsylvania, Jefferson’s primary market, up to 198,000 adults could lose Medicaid coverage under federal work requirements, according to an analysis from the Urban Institute. Many of these losses would likely result from confusion or administrative challenges.
“How do you make sure that you’re able to get ahead of that curve? We’re investing in navigation, in people and in technology to make sure that we’re keeping track of folks and of their eligibility — making sure that they’re able to get all the i’s dotted and t’s crossed to have their application resubmitted and be able to stay on insurance,” Dr. Yehia said.
With more people at risk of losing Medicaid, Ms. Cooper said it is imperative for systems to take stock of their access offerings and tailor them to the unique risks this population may face. For some people, taking time off work for a medical appointment could jeopardize their income or job stability.
“What would work for someone who just could not risk taking time away from work for fear of recrimination in the workplace? They’re working hard. Their Medicaid is at risk,” she said. “They can’t take a hit to their wages or their attendance because it could affect their long-term employment or stability of their family. So we have to think about, as a system, what access options are available and make it as easy as possible to get care.”
A return to pre-ACA strategies
In many ways, the strategies health systems are leaning on today mirror those from more than 15 years ago, before the Affordable Care Act significantly expanded coverage. At that time, many hospitals relied on local partnerships and free clinics to help patients access basic care.
While today’s healthcare landscape has a more structured safety-net infrastructure, many of the same tactics are resurfacing. Only this time, healthcare providers are operating under even greater financial and access pressures, requiring health systems to approach this work with more strategy and intention.
“It’s a little bit of ‘Back to the Future’ here.” Dr. Yehia. “We’re dusting off that playbook from before that we can now leverage.”
Moving forward, health system leaders say stronger policy action is needed to support safety-net providers and independent physician practices. Without additional support, a growing number of providers may be forced to scale back services or limit the number of uninsured patients they can accommodate. Such a shift could deepen strain on larger safety-net systems already caring for high volumes of Medicaid and Medicare patients.
“On a macro-level, we need to be aware of the delicate balance and web that keeps healthcare afloat in many areas,” Dr. Yehia said.
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