US hospitals brace for tougher 2027 as coverage losses and Medicaid cuts loom
XLV•HCA, Tenet and Universal Health Services reported third-quarter ACA exchange volumes down 17% to 19%. HCA expects the loss of federal subsidies to reduce 2026 income by up to $1.2 billion, while Medicaid payment changes could put roughly $60 billion in federal hospital funding at risk once fully phased in.
1. Coverage losses pressure hospitals
US hospital operators are bracing for revenue pressure as more people lose Affordable Care Act coverage and government aid for treating Medicaid patients potentially falls. HCA, Tenet and Universal Health Services reported steady admissions but said rising numbers of uninsured patients are squeezing operating margins; emergency care for uninsured patients often goes unpaid.
2. Financial effects vary
The end of federal subsidies for ACA health plans led premiums to rise and more than 3 million people to drop their plans. HCA estimates the subsidy loss could reduce its 2026 income by up to $1.2 billion. HCA, Tenet and Universal reported year-over-year declines of 17% to 19% in third-quarter ACA exchange volumes. HCA expects net supplemental Medicaid benefits to fall by $550 million to $650 million in 2027, while UHS forecasts a $175 million to $200 million hit.
3. Medicaid changes from 2027
Starting in 2027, certain working-age Medicaid adults will have to meet work or community-service requirements to keep coverage. In 2028, certain supplemental Medicaid payments will be reduced by 10 percentage points annually; KFF estimates roughly $60 billion in current federal hospital funding could be at risk once the changes are fully phased in. Tenet is relatively more insulated, with its outpatient surgery-center unit accounting for about 40% of third-quarter adjusted core earnings.
