Summary of the Key Points
This article emphasizes that the concept of "access to healthcare" has shifted from simply having a place to receive treatment to whether one can afford it, with insurance (the payer) playing a crucial role. Taking the United States as an example, the elimination of personal health insurance subsidies under the Affordable Care Act (ACA) resulted in millions of Americans losing their coverage, leading to decreased hospital revenues and increased bad debts. Hospitals have had to cut costs to survive. The ultimate conclusion is that effective insurance protection is essential for ensuring that people can afford medical care.
Detailed Analysis
1. Changes in Healthcare Access: From a Lack of Doctors to a Lack of Funds
Over the past 30 years, more hospitals have been built, and most people can find a place to receive treatment (except for a few top-tier facilities). However, the situation has changed due to the rising costs of new technologies (such as advanced equipment) and labor. Healthcare inflation is outpacing general price increases. Therefore, the ability to access medical care now depends on whether one has the money or insurance coverage to cover the expenses. After all, paying for healthcare out of pocket is only affordable for a minority; hospitals rely primarily on insurance payments, so the quality of insurance coverage directly affects people's willingness to seek treatment.
2. The End of U.S. Subsidies: Millions of Families Lost Insurance
The ACA provided subsidies to help low- and middle-income individuals purchase health insurance, but these subsidies were not renewed in 2025. As a result:
- Insurance premiums soared, with some deductibles exceeding $10,000 (the amount you must pay before the insurance starts covering costs);
- 17% of policyholders lost their coverage (more than 4 million people), and some estimates predict this number could rise to over 5 or even 6.3 million;
- For example, Centene, a major insurance company, saw its number of individual policyholders drop from 5.54 million to 3.58 million, a decrease of nearly 200%.
These lost policyholders were mainly from low- and middle-income families who could no longer afford the premiums due to the subsidy cuts.
3. Hospitals Facing Challenges: Reduced Revenues and Increased Bad Debts
With fewer insurance customers, hospital revenues have declined:
- HCA, the largest hospital chain in the U.S., suffered a loss of $150 million in the first quarter of 2026, with annual losses expected to range from $600 to $900 million;
- The number of individual policyholders admitted to hospitals decreased by 15%, while the number of uninsured patients increased by 16% (many of whom were previously insured);
- Uninsured patients often seek emergency care, but since they cannot pay, these treatments become "bad debts" for hospitals. Before the ACA, hospital bad debts had decreased from $62.8 billion to $42.4 billion; now, they are on the rise again.
4. How Hospitals Cope with the Challenges: Cutting Costs and Digitalization
To address declining revenues, hospitals are taking measures to save money:
- HCA plans to save $400 million by 2025 through cost-cutting strategies, such as using AI to replace some manual tasks (e.g., patient registration and record management) and improving employee efficiency;
- If necessary, they may lay off staff;
- They are also increasing their reliance on government-funded healthcare programs (such as Medicaid) due to the decline in private insurance revenue.
5. The Critical Lesson: Insurance Is Key to Access to Healthcare
Whether people lose their insurance or have insufficient coverage (e.g., limited reimbursement for expensive medications), it prevents them from seeking medical care:
- For example, 25% of low-income families with annual incomes below $40,000 opt for cheaper over-the-counter drugs instead of prescribed medication; 16% reduce their dosage in half. Only 15% and 8% of high-income families do the same.
- The conclusion is that only when insurance covers sufficient expenses will people feel confident enough to seek medical care, thereby truly improving healthcare accessibility.
This article illustrates through the U.S. example that the stability of the healthcare system is directly related to whether ordinary people can afford medical treatment and to the survival of hospitals. Insurance is not optional; it is essential for making healthcare services actually accessible to everyone.