Labeled as “self-pay,” this ER classification identifies people who lack insurance or did not prove they had it at the time they received care.
The new data reflects health systems’ concerns that more uninsured patients may flood emergency departments rather than seek primary care, due to significant healthcare shifts at the federal level.
Meanwhile, “safety net” providers like free clinics have cautioned that those who do seek primary care to prevent or manage illness will further strain clinics already tight operating margins.
State lawmakers have earmarked funding to boost free clinics and federally qualified health centers as well as create a state-level healthcare subsidy to offset losses to Affordable Care Act subsidies that Congress let expire earlier this year.
The forthcoming subsidy is expected to aid 200,000 Virginians, and will begin enrollment in November.
Virginians with various insurance types ranging from governmental to private sector held steady or had modest increases in ER visits, the association’s data shows.
Over 67,400 Virginians no longer have ACA insurance through the state marketplace, according to more recent numbers from the State Corporation Commission, compared to this time last year.
By January of next year, Medicaid beneficiaries will be subject to more stringent work requirements and twice-yearly verifications. While state and local social service departments ready themselves for additional verification workloads, thousands of Virginians may be more vulnerable to losing their insurance.
A recent state report also found that 13 rural hospitals in Virginia are at risk of closure amid the federal impacts to health insurance access.
Though some hospitals’ struggles can be traced back years and include demographic and regional shifts, current strains are attributed to Medicare and Medicaid reimbursement rate cuts, the federal reconciliation bill Congress passed last summer and the expired ACA subsidies.
Aubry Layne, chief administrative officer for Sentara, said earlier this year that the health system has become “more purposeful lately about getting the public to understand” the vulnerabilities.
Sentara’s Halifax Community Hospital was listed among the at-risk facilities.
Ballad Health officials — a chain with multiple hospitals identified in the state report — have also said they continue to engage with lawmakers.
VHHA spokesman Julian Walker reiterated that hospitals have a long history of adapting to change and may not be likely to close immediately or forever.
Adaptations may entail staffing or service cuts, which is already happening in Virginia, or closure of primary care clinics owned by hospital chains. Another method may be cost negotiations with private insurers.
“We will see what other measures might have to be taken to continue to sustain hospitals longterm,” Walker said.
Hospital ER staff must treat everyone who comes through their doors regardless of their ability to pay. But over time, systems have to offset costs of absorbing uncompensated care.
Layne, from Sentara, noted how his company has begun giving presentations to regional chambers of commerce and hosting roundtable discussions with healthcare workers along with state and federal lawmakers.
“We’ve been trying to get the message out that if you have commercial insurance and think ‘well, I’m not impacted by this’ — of course you will be,” he said.
