There’s a new Medicaid bill moving through the system,  H.R. 1 in the 119th Congress ( All Info – H.R.1 – 119th Congress (2025-2026): One Big Beautiful Bill Act | Congress.gov | Library of Congress) could create some real unintended consequences for hospitals.

While it may look like just another round of policy updates on the surface, what’s buried inside could have a real and immediate impact on hospitals.

The bill proposes significant changes. Able-bodied adults without dependents must work, volunteer, or participate in job training for at least 80 hours a month to keep their Medicaid coverage. That’s a tough bar for many; expansion states will feel these impacts the hardest.

In addition, recipients would now have to reverify their Medicaid eligibility twice a year, adding more paperwork, deadlines, and chances for people to fall off coverage. The bill also bars undocumented immigrants from accessing Medicaid and tightens eligibility standards.

At first glance, this might seem like a move toward accountability, ensuring people are working, staying eligible, and keeping the system tight. However, from the perspective of hospitals, especially those already stretched thin by high Medicaid and uninsured volumes, the unintended consequences could be serious.

What This Could Mean for Hospitals

Let’s get to the core issue: coverage loss.

Even people who should stay covered could lose access simply because they missed a deadline, didn’t report hours properly, or got tripped up by the new paperwork.

And when they lose coverage? They still get sick. They still need care and show up sicker and in your emergency room.

Here’s what we’re likely to see:

  • More uninsured patients are walking in the door, many with delayed or advanced health issues.
  • Higher ER volumes are for things that could’ve been handled earlier if the patient had coverage.
  • There is more pressure on hospital teams, who now have to explain why coverage was lost, help patients reapply, and do it all with the same (or fewer) resources.

And don’t forget about DSH payments. If the number of uninsured patients climbs and you don’t have a strong plan to identify and qualify those still eligible, you’re not just helping less; you’re eating more cost.