The Virginia Hospital and Healthcare Association is noticing a rise in patients who opt for self-pay in Virginia emergency departments.
鈥淭he number of people who visited a Virginia hospital emergency department (ED) as a self-pay patient 鈥� meaning they did not have insurance or did not present proof of insurance to pay for their care 鈥� reached a four-year high of 405,584 patients in 2025. That represents a 49% increase from 2022, when 272,185 ED visits were classified as self-pay,鈥� according to a statement from the Virginia Hospital and Healthcare Association.
Julian Walker, Virginia Hospital and Healthcare Association’s vice president of communications, said the rise in patients who do not have insurance, or proof of insurance, in Virginia emergency departments is alarming, especially considering recent changes in federal legislation.
鈥淚t suggests that there are more people who potentially are in the ranks of the uninsured and that is on the front end of some of the changes in H.R. 1, the Budget Reconciliation Act of 2025, sometimes called the One Big Beautiful Bill,鈥� he said.
The One Big Beautiful Bill will mean some .
鈥淭hat cuts healthcare funding significantly, about a trillion dollars over a decade period, and it is projected to lead to as many as 10 million Americans losing healthcare coverage and potentially 300,000 or more Virginians losing healthcare coverage,鈥� Walker said.
If the trend among those who rely on self-pay in emergency departments continues, hospitals are worried about other impacts.
鈥淭hat leads to more charity care, and in turn, that leads to higher costs, even for people who are not engaged in the Medicaid system, who are connected to commercial insurance through an employer-sponsored plan. The employer has to pay more. The worker pays more in terms of their withdrawals from their paychecks, the premiums, copays, co-insurance, out-of-pocket costs, high-deductible plans, all of those things,鈥� Walker said.
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