Virginia hospital emergency departments recorded an 8% increase last year in visits from uninsured patients, according to new data from the Virginia Hospital and Healthcare Association.
Hospitals classify those visits as “self-pay,” meaning patients lacked insurance or did not show proof of coverage when they received care.
The association said the increase comes as health systems and safety-net providers prepare for changes in health coverage. Hospitals have raised concerns that more uninsured patients may turn to emergency rooms instead of primary care, while free clinics said additional demand could strain already tight budgets.
State lawmakers set aside funding to support free clinics and federally qualified health centers, and to create a state subsidy after Affordable Care Act subsidies expired earlier this year. Enrollment in the Virginia subsidy is expected to begin in November and aid about 200,000 residents.
Emergency room visits among Virginians with other forms of insurance, including government and private coverage, were steady or rose modestly, the association’s data showed.
More than 67,400 Virginians no longer have Affordable Care Act marketplace insurance compared with this time last year, according to the State Corporation Commission.
By January, Medicaid beneficiaries will face stricter work requirements and twice-yearly eligibility checks. State and local social service departments are preparing for added verification work, and more Virginians could lose coverage.
The report said some hospitals’ difficulties predated current policy changes and also reflected demographic and regional factors. It attributed current pressure to Medicare and Medicaid reimbursement cuts, the federal reconciliation bill Congress passed last summer, and the expired Affordable Care Act subsidies.
Virginia Hospital and Healthcare Association spokesman Julian Walker said hospitals have a long history of adapting and may not close immediately or permanently. He said responses could include staffing or service reductions, the closure of hospital-owned primary care clinics, or negotiations with private insurers.
“We will see what other measures might have to be taken to continue to sustain hospitals longterm,” Walker said.
Hospitals must treat emergency room patients regardless of their ability to pay, but systems must absorb or offset uncompensated care costs over time.