Medicaid was supposed to be the solution. Then came the affordable care law. But while the rate not insured in America has reached historic stockings, the financial burden of patients continues to increase.
According to the most recent estimates, 26 million Americans remain uninsured – half of the number before the ACA – but uninsured patients can represent almost 40% of dollars due to hospitals. Despite a coverage extended by Medicare, Medicaid and the ACA, the gaps persist, leaving millions of people not insured or under-assured. Consequently, hospitals see an increasing share of income related to patients who find it difficult to pay, which has led to an assembly of unpaid bills which have an impact on individuals and health care providers.
For the health care industry, this crisis is not only a question of financial risk – it is the confidence of consumers. When patients cannot afford the care, they disengaged, often convinced that the system is not designed for them. And when confidence is eroding, the results too – because people who do not trust the system are less likely to ask for care. Surprise invoices, opaque prices and unaffordable exceptional costs send a clear message: “You are alone.”
We know of medicine that prevention is the best remedy, because an early intervention reduces costs and improves results. The financing of health care must adopt the same state of mind. Instead of reacting to financial difficulties after that, providers must adopt financial preventive care – invest in a proactive commitment, smart navigation and a real -time financial match to connect patients with good resources before falling in crisis.
So who is alone now, and why are there so much?
Medicaid’s “relaxation” process has stripped more than 25 million people from their coverage in just two years. While some have moved to market plans with improved federal subsidies, many remain taken in a gap, forced to pay your pocket for the care they cannot afford. Financial tension is not only a burden for patients; It is devastating for suppliers, who could recover less than ten hundred from the dollar when the services are not remunerated.
And this is only the beginning. The funding of Medicaid is under control, with huge potential cuts, changes in the financing of expansion and new work requirements on the table – threatening coverage for the 79 million Americans who are on the program. Improved federal subsidies for the plans of the ACA market, which served as a financial rescue buoy, should expire at the end of 2025 unless the Congress intervenes. If they disappear, the premiums could increase up to 75%, forcing millions in the ranks of the unwanted. The Congressional Budget Office provides that an average of 3.8 million Americans could lose coverage each year between 2026 and 2034, which left them a medical emergency far from the financial disaster.
In the absence of federal intervention, hospitals absorb the burden of the financial distress of patients and are now responsible for collecting more dollars with patients less able to pay. But it is also up to hospitals to change this dynamic, not only to protect their balance sheets but to restore the confidence of patients. A response lies in the redefinition of financial experience not as a transactional process, but as an extension of patient advocacy. This means meeting patients where they are, guide them to financial resources before falling into crisis and ensuring that they are not left at the time for the challenges of affordability.
But the resolution of this on a large scale requires more than just a policy or better communication – it requires care and a technology centered on the patient which can anticipate financial tension and intervene before it becomes a crisis.
Automation fueled by AI can provide hospitals with an evolutionary preventive solution. Each year, billions of dollars of financial aid are not used due to fragmented systems and a lack of awareness. For example, there are about $ 138 billion in HSA accounts and $ 3 billion are lost unused FSA accounts each year. Another example: despite the discharge of $ 5 billion each year in patient support programs, pharmaceutical manufacturers only obtain 3% of patients eligible to register and use their programs.
AI tools can proactively connect patients to these underused financial resources, such as the automated registration of Medicaid, co-payment assistance in pharmacies and HSA / FSA funds, by removing obstacles that often keep help out of reach. By identifying patients at risk early and guiding them to the right support before invoices become unmanageable, hospitals can mitigate patient financial pressure while improving their results.
The future of the affordability of health care will not be shaped by policy alone, but perhaps despite this. Hospitals and health systems can choose to direct today. The personalization of billing experiences for patients, the automation of tracks that connect them to financing resources and the identification of patients at the highest risk of default with upstream interventions would begin to counter the swelling crisis. Providers who invest in financial navigation solutions will not only protect their financial stability; They will redefine what it means to provide care centered on the patient.
Photo credit: Mkurtbas, Getty Images
Seth Cohen is president of Cedar, the main financial platform of patients for health care providers, and is a member of its board of directors. Previously, Seth was CEO and co-founder of Ooda Health, a health technology company acquired by Cedar in June 2021. Before Ooda Health, Seth was one of the first employees of Castlight Health and was part of the management team. He was a member of the board of directors of Castlight until May 2022, when Castlight was acquired by CD&R and merged with Vera Whole Health. Before his visit to Castlight, Seth was a management consultant at McKinsey & Company in the practice of payers and health care providers. Seth obtained an MBA from the Harvard Business School as a Baker and MPA scholarship holder of the Harvard Kennedy School. Seth completed his undergraduate studies at Stanford University as Phi Beta Kappa. Apart from work, Seth likes to spend time outside and perform impromptu musicals with her three young children.
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