More Hoosiers go uninsured, resulting in higher emergency department usage

INDIANA - Indiana hospitals are reporting a double-digit increase in the percentage of emergency department visits since the start of 2025 — a rate that is expected to climb as more Hoosiers go without health insurance or opt for high-deductible plans to offset surging premiums.

Nearly 60,000 fewer Hoosiers signed up for insurance through the Affordable Care Act exchanges this year following the expiration of enhanced tax credits that once kept their monthly premiums low, researchers from health policy group KFF found in an analysis last month.

Another 400,000 Hoosiers are no longer covered by Medicaid since the Indiana Family and Social Services Administration imposed additional eligibility checks, with still more Hoosiers expected to lose coverage when work requirements take effect in January.

Meanwhile, those insured through employer plans are reporting unsustainable monthly premiums, pressuring them to consider high-deductible plans or forego coverage altogether.

Health and anti-poverty advocates say the trends could result in worse health outcomes, delayed and uncompensated medical care — and ultimately more medical debt for Hoosiers.

The expiration of enhanced tax credits from the American Rescue Plan, adopted in 2021 to lower monthly premiums for Americans insured through ACA plans, resulted in 23 million fewer Americans signing up for ACA coverage this year, according to KFF.

The plans are used by Americans who earn too much for Medicaid yet cannot afford or are not eligible for insurance through their employer.

The health policy group found the average ACA premium hit $178 a month — a 58% increase over 2025. That is still lower than anticipated, as people either declined coverage or opted for high-deductible plans.

Indiana reported the fourth-highest decline in ACA sign-ups this year, tied with Delaware and Arizona at a 16% decrease from 2025, when 359,240 Hoosiers were covered by ACA plans.

Only 300,049 Hoosiers enrolled in ACA plans this year, KFF found.

The health policy group anticipates more Americans will lose coverage as the year progresses and they are unable to keep up with premiums.

The KFF report found a disproportionate share of Americans who dropped ACA coverage are in middle-income households earning too much for what remains of the premium subsidies.

Hoosiers insured through their employers are struggling to afford their premiums too.

Emergency department visits in Indiana increased by nearly 17% in 2025, far higher than the 1.4% increase reported nationally.

IHA reports much of the decline in coverage is due to the Medicaid eligibility redetermination process, while federal policy changes like Medicaid work requirements and the expiration of ACA premium tax credits is expected to further fuel the trend this year.

Some hospitals are reporting to IHA a projected doubling of bad debt in 2026, at a time when the association is already projecting an additional $3.3 billion in uncompensated care for Indiana hospitals over the next decade due to federal policy.