More Americans paying out-of-pocket in the ER as Medicaid rolls shrink

Medicaid coverage losses are hitting low-income patients where it hurts most — their wallets. A new Epic Research study analyzing over 550 million U.S. healthcare encounters found that self-pay emergency department visits climbed from 5.5% in early 2022 to 7.6% in Q2 2026, almost exactly mirroring a decline in Medicaid ER encounters over the same period. The trend spans every care setting studied, from inpatient admissions to births to primary care.

The backdrop: Medicaid swelled to cover 1 in 4 Americans during the pandemic, but post-pandemic eligibility redeterminations led to more than 25 million people losing coverage. Now, the GOP's "Big Beautiful Bill" — passed last July — is piling on with nearly $1 trillion in additional Medicaid cuts, including new work requirements and more frequent eligibility reviews.

By the Numbers:

• Self-pay ER visits: 5.5% (2022) → 7.6% (2026)
• Medicaid ER encounters: 18.2% → 16.1%
• Medicaid inpatient encounters: 13.2% → 11.7%
• Medicaid birth encounters: 23.1% → 21.5%
• ~6 million people projected to lose Medicaid over the next decade (CBO)

Why it matters: As healthcare costs continue to climb and coverage safety nets shrink, more low-income Americans are being left to foot the bill themselves — particularly in emergency situations where care can't wait. With midterm elections approaching and healthcare costs topping voter concerns, this trend is both a clinical and political flashpoint.