The number of ED visits to Virginia hospitals by people without health insurance increased 49 percent between 2022 and 2025 – and that number is only going to go up with the Trump/MAGA Big Beautiful Bill from last summer taking millions more off the Obamacare rolls.
Donald Trump has been saying for 10 years that he has the framework of a plan to fix healthcare; it seems that his fix is to just let the healthcare system – and with it, people, and local hospitals – die.
The numbers on ED visits come from the Virginia Hospital & Healthcare Association, which reports that there were 405,584 patient visits in calendar year 2025 from so-called self-pay patients – people who told the person at the sign-in desk that they did not have insurance, or did not present proof of insurance to pay for their care.
That was up from the 272,185 self-pay ED visits in 2022.
Again, the increase is 49 percent from 2022 to 2025.
The pressure on hospitals is spelled out in this figure: self-pay ED visits account for 10 percent of all emergency department visits.
Take an educated guess on who ends up eating the costs associated with those visits.
If you went with “the hospitals,” you win the pony.
In 2024, before Trump and the Ben Clines of the world had their way with the healthcare system, Virginia hospitals absorbed a $1.4 billion Medicare shortfall – the gap between Medicare reimbursement and the actual cost of providing care.
Also in 2024, our hospitals provided $457 million in charity care to uninsured and underinsured patients and incurred $428 million in bad debt from unpaid medical bills.
Those numbers – all of them, the Medicaid shortfall, and the charity care and bad debt – all going up, going forward.
Per a memo from VHHA, we can expect that the Big Beautiful Bill will increase the numbers of self-pay patients.
On top of that, the Triple-B will cut $7 billion – billion, with a b – in annual Medicaid reimbursements to Virginia hospitals.
So, we’re going to have more self-pays, and hospitals are not only going to have to eat those costs, but they’re also going to be getting a lot less from the federal government to balance their budgets.
When your local hospital announces that it’s cutting services, or if you’re in a rural area, and it just turns out the lights for good, you know who to thank.
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Chris Graham
