Uncompensated care to rise by $283B under reconciliation bill

The latest projections from the Robert Wood Johnson Foundation show even higher uncompensated care costs and provider revenue hits under the House's reconciliation bill.

The analysis prepared by the Urban Institute for the Robert Wood Johnson Foundation (RWJF) estimated an increase of $283 billion in uncompensated care sought by uninsured people between 2025 and 2034. This is more than the $278 billion increase projected by the same researchers in a May 29, 2025, analysis.

Hospitals would still experience the most significant increase in uncompensated care during the period, with the latest analysis projecting $85 billion in hospital-related uncompensated care.

Meanwhile, physician services would see a $34 billion increase in uncompensated care from uninsured people. The rest of the projected $283 billion in uncompensated care would come from prescription drugs ($56 billion) and "other services" ($108 billion).

States that would see the greatest increase in uncompensated care under the House reconciliation bill would also be California ($27.5 billion), Texas ($15.9 billion), New York ($13.1 billion) and Florida ($11.7 billion). These are the four most populous states, researchers pointed out.

Researchers said the level of uncompensated care sought by the uninsured if the House reconciliation bill is passed as is stems from an updated methodology designed to produce state-level estimates on policy changes under the so-called "Big, Beautiful Bill."

Additionally, the analysis accounted for updated uninsured projections from the Congressional Budget Office (CBO) released on June 4, 2025. CBO estimated 16.0 million more uninsured people from Medicaid and Affordable Care Act (ACA) provisions in the bill and the expiration of enhanced premium tax credits for health plans sold through the ACA marketplaces.

Researchers said the uncompensated care estimates, while an increase compared to the previous analysis, still likely represent lower-bound projections.

Overall, the latest analysis showed a $1.06 trillion decrease in healthcare spending from 2025-2034 under the House reconciliation bill and the expiration of enhanced premium tax credits.

The House reconciliation bill's provisions alone would account for $797 billion of the decline in healthcare spending, according to the analysis.

Hospitals would still face the greatest reduction in healthcare spending at an estimated $424 billion -- 40% of the total estimated decline in healthcare spending. Physician services would see a $120 billion decrease, as prescription drug spending would drop by $241 billion and "other services" by $275 billion.

"The Medicaid cuts Congress is considering would be the largest funding reduction in the program’s history, and it is hard to overstate just how devastating the impacts would be," Katherine Hempstead, senior policy adviser at RWJF, said in a statement. "Such drastic changes to Medicaid financing would have ripple effects that go well beyond people covered by the program, further squeezing hospitals, limiting access to care for entire communities, and destabilizing state and local economies."

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.