Louisiana hospitals see sharp uptick in uninsured patients after Obamacare subsidies expired

WASHINGTON – Louisiana hospitals are reporting a surge of uninsured patients seeking treatment, many of whom dropped their policies when Congress last year didn’t extend the subsidies that helped lower-income workers buy health insurance through the Affordable Care Act marketplace.

Recent federal reports show that about 3 million fewer enrollees nationally kept the subsidized coverage offered to people who make too much money to qualify for Medicaid, the state-federal medical insurance coverage for low-income residents, but not enough to buy the policies on their own.

Louisiana was among the states that saw the biggest proportion of ACA Marketplace enrollees dropping their coverage, according to a Kaiser Family Foundation analysis of federal reports released at the end of July. The state went from 264,790 enrollments in March 2025 to 195,759 for the same time this year – a 26% decrease.

KFF is a prominent Washington-based health care think tank.

Health care affordability is a key issue in the November 3 midterm elections that will decide which party controls the U.S. House and, perhaps, the U.S. Senate.

Democrats accuse Republicans of tearing care away from constituents. The GOP and the Trump administration argued taxpayers were subsidizing health insurance for too many people with good incomes. They also argue the decline in coverage is less a result of increased prices and due more to its effort to rid federal healthcare programs of “waste, fraud, and abuse.”

Adjacent to the political fray on Capitol Hill, hospitals nationally and in Louisiana report losing millions of dollars so far this year because providers are legally required to provide treatment regardless of whether the patient can pay – and, with the government’s decision to lower its expenditures by not renewing the enhanced subsidies, the number of those patients is going up.

“This is a policy problem that will have very human consequences,” said Ryan Cross, chief government relations officer for the Franciscan Missionaries of Our Lady Health System Inc., which owns hospitals and clinics in Louisiana and Mississippi. That includes Our Lady of the Lake Regional Medical Center in Baton Rouge, the state’s largest.

“We’ve seen 2,500 more uninsured patients visit our emergency departments during the first 6 months of 2026 compared to the same time in 2025,” Cross said, adding that uninsured behavioral health admissions increased 113% during the same time period.

Hospitals seeing the impact

That translates into financial losses for healthcare providers.

Lake facilities, for instance, wrote off about $2.3 million more in bad debt for April through June – a 23.4% increase compared to January, February and March, Cross said.

Cross explained that someone with insurance can pay for managing their health conditions. Many patients, not just those who are low-income, can’t afford the expenses on their own and rely on insurance to cover costs.

“When that congestive heart failure goes unmanaged because they don't seek care, they don't refill their meds and it flares up, it can be life threatening and very expensive,” Cross said. “It’s much cheaper and much healthier for them to seek that care on the front end than have to show up in an ambulance at my emergency room.”

Baton Rouge General Hospital reports about 3,000 more patients arriving without insurance.

“Healthcare is already a business with pretty thin margins, so we’re always looking for ways to be more efficient. That’s everything from how we purchase supplies to how we staff our departments. At the end of the day, our goal is to make sure we're using our resources wisely so we can continue providing great care for our community,” hospital administrators said in a statement.

Other health care providers across Louisiana have privately raised similar concerns.

The big national chains are warning their shareholders of the losses. Some are considering dropping services, like behavioral health, to help make ends meet, according to a new report prepared by researchers at the Urban Institute, with support from the Robert Wood Johnson Foundation.

Plus, the 276 Affordable Care Act insurers are raising premiums, filing show – for the second year in a row – by about 15% more for 2027 policies according to a KFF analysis released last week.

“We’re closely watching the trends. It’s a growing problem. We have to have an honest conversation about it in Washington,” Cross said.

Up in Washington, U.S. Rep. Troy Carter, D-New Orleans, said he’s heard from a lot of Louisiana hospitals and healthcare providers.

“The facts are clear. Louisiana experienced one of the nation’s largest Marketplace enrollment declines because families could no longer afford coverage after the enhanced premium tax credits expired and premiums surged. That’s not fraud or abuse; that’s working families being priced out of health insurance,” Carter said.

What changed?

Set up under the Affordable Care Act, sometimes known as Obamacare, the marketplace covers the gaps for people who make too much money to qualify for Medicaid, the state-federal government insurance, but too little to buy policies on the open market. The various policies provide differing levels of coverage through private health insurers.

Obamacare also provided a range of subsidies, mainly based on annual income and household size, for those who couldn’t fully afford the costs. Depending on income, many policyholders ended up not having to pay out of pocket for any insurance expenses, while others paid reduced amounts.

During the COVID pandemic, the Trump and Biden administrations lowered Medicaid qualifications to make sure more people had insurance coverage. As the pandemic lessened, the Biden administration expanded who could receive subsidies to buy policies in the ACA marketplace.

Those subsidies were set to expire December 31, 2025. Republicans argued against extending the subsidies and Democrats argued to continue them.

That debate caused a 43-day shutdown of the federal government late last year.

The expiration of subsidies was expected to leave 24.2 million Americans — small businesses, gig workers, independent contractors, early retirees and others — paying more, many twice as much for their health insurance this year compared to last, according to the Congressional Budget Office.

The Congressional Budget Office estimated 2 million people in 2026 could no longer afford health insurance and would drop their policies, with increasing numbers thereafter. The Urban Institute calculated 5 million would lose insurance because the financial cushion was removed.

Republicans generally argue that the enhanced tax breaks, which cost upwards of about $30 billion to help cover about 10% of the population, unnecessarily spent taxpayer money on families with six-figure incomes.

KFF recently published an analysis of the government’s numbers and found every state — except New Mexico, which covered the lost subsidies for its citizens, saw decreases in ACA Marketplace enrollments. That’s a total of three million nationwide dropping out, leaving 19.6 million beneficiaries.

Cutting care or fighting waste?

Just how this decline happened is the source of differing interpretations.

Republicans, who fret over escalating costs, say the drop in coverage is a result of their successful effort to rid government-subsidized health care of waste, fraud and abuse, which they say is using up money to fund healthcare for the truly needy.

Democrats, whose worry too many are going uninsured, point to government policies that have made insurance too expensive and too difficult for many to get.

The government reports and KFF analysis of those numbers don’t detail why the ACA Marketplace policies were dropped.

The U.S. Department of Health & Human Services recently stated that 5.6 million people were improperly enrolled in 2025 and that 2.9 million were removed for a variety of reasons. Health Secretary Robert F. Kennedy Jr. said at a press conference that his agency had uncovered instances of fraud, such as brokers who signed up people without their knowledge.

Others have a different take.

Courtney Foster, a senior Medicaid policy advisor for the progressive think tank and advocacy group Invest in Louisiana, based in Baton Rouge, said the most likely reason is because enrollees couldn’t afford to continue paying such high rates on their incomes.

“We saw a huge drop off of people who maybe had originally selected the plan, but then once it came time to actually pay that premium for whatever reason, didn’t,” Foster said.

“Many employers may not be able to offer health insurance to their employees and may send them to the marketplace. But the employees, when they find that the coverage options are limited and really expensive, then they may have to make some really difficult choices.”

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