Protecting patient access amid financial pressure

Hospitals and health systems are facing a difficult combination of policy, market, and operational pressures that could reduce insurance coverage rates, challenge access to care, and reshape provider economics over the next several years.  

At Guidehouse’s 2026 Healthcare Innovation Summit, provider leaders described how they’re working to protect patient access while maintaining financial stability.  

Moderated by Alyssa Keefe, Senior Vice President and Head of Policy at the Federation of American Hospitals, the panel featured a broad, candid discussion about the future of access and provider economics. At the event, panelists shared how they’re forecasting coverage shifts, adapting operations, and engaging their communities to sustain access to care. 

Coverage changes will affect each market differently

Keefe opened the discussion by describing changes to Medicaid created by H.R. 1, including work requirements, more frequent eligibility determinations, changes to retroactive coverage, and future constraints on provider taxes and state-directed payments. 

As these policy challenges affect insurance coverage and increase uncompensated care, they’ll add to already significant margin pressures for hospitals, with safety net and rural facilities likely to be disproportionately affected.  

Impact will vary widely across the nation based on each health system’s payer mix, geography, and local coverage dynamics, said Nathan Summar, Senior Vice President, Revenue Management at Community Health Systems (CHS), which operates 60 hospitals across 12 states. He shared that he expects Medicaid work requirements and other eligibility changes to reduce patient volumes, worsen payer mix, and overwhelm emergency departments as patients delay care. Emergency departments are required by law to stabilize patients regardless of insurance coverage. 

“A lot of patients are not going to come back into the hospital again—they’re not going to seek care,” Summar said. “Those that do come in, you're going to have a deteriorated payer mix because they're going to come uninsured into an environment that is most costly to us: the emergency room. 

Adapting operations with data in mind

Panelists emphasized that national coverage estimates are important but insufficient for organizational planning. Summar said health systems need to understand how coverage changes show up in their own data, including by state, service line, and patient behavior. 

Looking back at Medicaid redeterminations after pandemic-era coverage protections expired, CHS saw Medicaid patient volumes decline roughly 7% to 10% in states where broader disenrollment estimates were much higher, he said. That difference reinforced the need for analytics dashboards that can track patient volume, payer mix, and transactional activity in real time. 

“The only way that you could really forecast that information is you have to have it in the first place,” Summar said. “Investing in those data systems is really the only way you can get the right answers. 

Keeping patients informed

Kathy Levins, Vice President, Public Policy and Government Affairs for Temple Health, said the Philadelphia-based academic health system is preparing for the impacts of H.R. 1 on its patients by focusing on community engagement and practical advocacy. Temple Health is a major safety net provider across the city, with Temple University Hospital caring for the highest volume and percentage of Medicaid-covered patients in Pennsylvania. 

The organization is already planning and implementing strategies to help patients navigate work requirements, eligibility redeterminations, and other coverage changes. Clinicians are being encouraged to document medical frailty in the EHR, which may help sustain coverage for patients who may be exempt from Medicaid work requirements. The health system is also making sure patients are aware of the changes by sending messages to those whose coverage may be affected, holding town halls with elected officials, and participating in health fairs. 

“No panic, no doom and gloom,” Levins said. “We're all going to get through it, but we need to be ready for what's coming at us next.” 

For Levins, the work also depends on clear, credible communication with policymakers. She encouraged provider leaders to clearly articulate to local, state, and federal policymakers how proposed rules and financing changes will specifically affect their local institutions, communities, and patients, rather than relying solely on national talking points. 

“Tell your story and tie it to your needs assessment,” Levins said. “Figure out what's relevant in your community, because that's also going to be relevant to your policymakers. 

Credibility and mission will matter most

Throughout the discussion, panelists returned to a common message: financial sustainability cannot be separated from access, mission, and trust. Organizations will need to make hard decisions, but panelists said those decisions should be guided by data, grounded in community needs, and communicated clearly to policymakers and stakeholders. 

As policy changes accelerate and financial pressure intensifies, the ability to protect access will depend on how well health systems connect strategy to execution. That means using data to understand local impact, redesigning operations around sustainability, supporting their workforce, and telling a credible story about what communities need.