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No matter how the midterms shake out, hospitals shouldn't expect Washington to ride to the rescue anytime soon. Consultants from BRG warn that the sweeping Medicaid and Medicare changes baked into H.R. 1 will compound financial pressures already squeezing health systems. Leaders say survival will require aggressive cost cuts, smarter revenue strategies, and a long-term mindset — not a political lifeline.
Hospitals hoping the midterm elections would deliver a financial reprieve are in for a rude awakening. BRG healthcare consultants told health system leaders this week that the policy headwinds — driven largely by H.R. 1's Medicaid work requirements, state-directed payment restrictions, and the expiration of ACA subsidies — are here to stay, regardless of which party controls Congress. Amending the "One Big Beautiful Bill Act" would require significant political concessions, making a swift fix unlikely.
Health systems are being urged to stop waiting and start acting. That means building detailed financial exposure models, protecting Medicaid enrollment ahead of January deadlines, and pursuing cost reductions of an additional 5–7% beyond what they're already doing. Leaders from CommonSpirit Health and AtlantiCare confirmed they're already making tough calls — from renegotiating payer contracts (sometimes going out-of-network) to consolidating service lines like OB and pediatric ICUs.
Key Takeaways:
Why it matters: With coverage losses mounting and supplemental payments shrinking, hospitals face a structural financial shift that no election outcome can quickly reverse — making proactive strategy the only real option.
