CLEVELAND, Ohio

Research from KFF indicates that many Americans lacking health insurance may be eligible for Medicaid or Affordable Care Act plans. However, they often face significant barriers such as a lack of awareness about their eligibility or difficulty in finding affordable options.

MetroHealth System is making a concerted effort to understand the reasons behind uninsured individuals and to ensure they enroll in Medicaid, Medicare, or Affordable Care Act plans. This initiative aims to connect patients with necessary coverage.

With the increasing amount of charity care, MetroHealth is looking to alleviate some financial pressure. Currently, the health system spends approximately $1 million daily on charity care—an amount that has surged over recent years.

Recent critical care cuts will be part of broader strategies, including layoffs and possible closures of county safety net hospitals, to address the financial challenges posed by changing government policies.

The costs incurred by uninsured individuals can quickly spiral into medical debt, especially since many have little in savings. A KFF research paper from 2024 examines the uninsured population—why they lack coverage and how it affects their access to health care.

There are upcoming changes to Medicaid funding that could limit enrollment, according to KFF. These changes may include new work requirements that could further reduce the number of people receiving Medicaid.

Without a permanent extension of marketplace subsidies, estimates suggest that the number of uninsured Americans could rise by an average of 3.8 million each year from 2026 to 2034, due to expirations starting in 2025.

The Affordable Care Health Insurance Marketplace is a federal resource aimed at helping individuals and small businesses compare and enroll in health insurance plans that fit their needs.

In terms of financial burdens, MetroHealth’s charity care expenditures have ballooned from about $176 million in 2021 to around $276 million in 2024, with early reports for 2025 highlighting costs of about $184 million.

KFF’s study mainly focuses on health coverage for those under 64 since Medicare generally covers those over 65. The analysis used data from the 2022 and 2023 American Community Survey.

Here are some notable statistics concerning Americans facing health insurance shortages:

• The number of uninsured individuals under 64 remained steady at 25.3 million in 2023.
• Conversely, uninsured children rose from 3.8 million in 2022 to 4 million in 2023.
• Most uninsured individuals come from low-income households, with at least one working family member, and adults aged 19-64 are more likely to be uninsured than children.
• In 2023, 63% of uninsured adults aged 18-64 stated the high costs of coverage as their primary reason for lacking insurance.
• Many uninsured individuals do not have coverage through their employer.
• Those without insurance are more likely to hesitate or skip necessary medical care due to costs. Some studies indicate that Medicaid expansion correlates with reduced mortality rates related to various serious health conditions.

Focusing on regional statistics, the uninsured rate for those under 64 in the US was noted at 9.5% in 2023.

This includes a breakdown of uninsured rates in Ohio and nearby states. All listed states have expanded Medicaid:

• Indiana: 8.1%
• West Virginia: 7.5%
• Ohio: 7.4%
• Kentucky: 6.7%
• Pennsylvania: 6.6%
• Michigan: 5.4%

Nonprofit hospitals are mandated to provide charitable care, which the IRS defines as free or discounted medical services available to eligible patients who cannot cover their expenses. This is a requirement for hospitals to maintain their tax-exempt status under federal law.

Nonprofit hospitals may offer charity care to both uninsured and insured individuals, depending on eligibility criteria. MetroHealth employs a sliding scale to determine who qualifies for this charity based on federal poverty guidelines, providing higher charity support to Ohio residents compared to non-residents.

Patients whose income falls below these poverty guidelines may qualify for significant bill reductions if they meet additional criteria, according to MetroHealth’s policies.

As MetroHealth and other hospitals across the country brace for future changes in government funding, uncertainties loom large. Back in July, Congress enacted the largest Medicaid cut in the program’s history, based on a significant bill championed by the previous administration. Health policy analysts have stated that this legislation may reduce Medicaid funding by about $1 trillion over the next ten years.

While some advocates argue that cuts will prevent misuse of the system, estimates from the Congressional Budget Office suggest that around 11.8 million Americans could lose their health insurance as a result.

This situation places added financial strain on hospitals, which may need to provide more care to uninsured populations while managing increased costs and service reductions.

In Cuyahoga County, approximately 30% of residents rely on Medicaid for their health coverage, highlighting the importance of addressing these systemic issues in healthcare.