Looming uninsured surge may overwhelm ERs. Here’s who can help

Modern Healthcare – Monday, August 18, 2025
By Alex Kacik

Health systems are deploying an often-overlooked resource to combat a potential increase in uninsured patients — community health workers.

Health systems hope community health workers can help prevent people from losing insurance coverage due to expiring subsidies for health insurance exchange customers and the new tax law. Providers warn a rush of uninsured people could overwhelm already overcrowded emergency departments and hospitals.

Even if uninsured rates increase, employees who are embedded in the community can help keep people connected to the healthcare system and reduce unnecessary emergency department visits, executives said.

“There are tons of opportunities to better integrate community health workers across the healthcare system,” said Dr. Bechara Choucair, chief health officer at Kaiser Permanente. “Community health workers play a significant role in helping people access services and coverage.”

Providers are bracing for a potential influx of uninsured patients, who tend to defer care and use the emergency department more frequently than those with coverage. The “Big Beautiful Bill” is expected to result in 11.8 million Americans losing insurance by 2034, according to projections from the Congressional Budget Office. The tax law is poised to cull Medicaid enrollment in early 2027 through work requirements and rigorous eligibility redeterminations.

Millions more may lose their insurance if Congress does not extend enhanced subsidies that help curb premiums for Affordable Care Act exchange customers. Hospitals across the country are working with policymakers to get them to extend those subsidies and limit coverage lapses.

Many systems are already managing rising emergency department utilization and sicker patients, creating care backlogs, driving up costs and limiting access. A spike in patients without insurance would accelerate those trends, experts said.

It’s a snowball effect, said Anna Adams, chief government relations officer at the Georgia Hospital Association.

“When patients don’t have coverage at all and can’t get annual wellness checkups or see specialists, they go into the emergency department with significant problems because it is the only option,” she said. “The emergency department is not only an inappropriate care setting, but it creates a volume issue where emergency departments are full and they have to divert patients.”

Health systems, including Kaiser, are leaning on community health workers to keep low-acuity patients out of the emergency department, boost preventative care and maintain insurance coverage, Choucair said.

The Oakland, California-based integrated health system launched a pilot program in the Pacific Northwest about five years ago that placed community health workers in care teams that identified patients who were likely to end up in the emergency room or hospital. Community health workers used the question, “What do you need to improve your health?” to guide a treatment plan where those employees offered coaching, social support, advocacy and guidance.

The program, which Kaiser is expanding across the Pacific Northwest, the mid-Atlantic region and potentially other markets, has led to an annual reduction of roughly two fewer days in the hospital per patient and $82 in monthly savings per member, Choucair said. The return on investment for community health workers is more than 2-to-1, he said.

Community health workers could play an even bigger role in preventing lapses in coverage by helping people with paperwork, collecting patient data and connecting them with job opportunities and other community resources, Choucair said.

“There is no doubt that this type of model can be helpful for people navigating eligibility requirements and access to services and benefits,” he said. “Community health workers could add a ton of value here.”

Community health workers typically focus on preventative care. They can help people navigate coverage and teach residents in low-income areas about prenatal care, screenings, healthy eating habits and community-based resources.

But health systems have been relatively slow to focus on such strategies, despite executives who often say their organizations are bridging gaps in transportation, housing, nutrition, employment and other social determinants of health. Services that community health workers provide may not be covered by insurance, which is in part why hiring has lagged.

But hospitals are planning to recruit more community health workers, executives said.

“We are interested in working with community organizations to identify individuals at risk of losing coverage because of work requirements and preemptively help someone qualify for an exemption or connect them to an employment opportunity,” said Mark Schaefer, vice president of system innovation and financing at the Connecticut Hospital Association.

Insurers have also increasingly pushed early treatment interventions through alternative payment models, incentivizing the hiring of community health workers.

Alternative payment models that reward providers for decreasing costs, reducing hospitalizations and improving outcomes have fueled Endeavor Health’s team-based care models, said Dr. Sanjeeb Khatua, chief physician executive at Endeavor.

The Chicago-area health system plans to expand and better integrate its care teams, consisting of pharmacists, social workers, community health workers, care coordinators, advanced practice practitioners, primary care physicians and specialists, across its network, he said.

“We’re learning how to intervene with patients from a social perspective in a different way, which traditionally health systems haven’t been great at,” Khatua said. “What’s happening [on a federal level] is going to make us move quicker on partnerships to help us with that.”

These types of care models will not only help patients maintain insurance coverage by identifying at-risk patients, but they will also help direct people without insurance away from the emergency department to the right location, he said.

“Our duty is to make sure people have the coverage they are supposed to get,” Khatua said. “Most health systems are going to have to augment team-based care with technology that allows us to identify these patients further upstream and build the care models that are going to be needed to alleviate the pressures to come.”

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