Richmond ERs see uninsured surge before Medicaid changes hit
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More Richmond-area patients are showing up at emergency rooms without insurance, and Virginia officials warn the trend may worsen statewide as new federal Medicaid changes roll out this fall.
Why it matters: State leaders say the health care system can't absorb additional coverage losses, with costs potentially spilling over to insured Virginians.
- "When Virginians lose their health coverage, premiums will go up for everyone else," Gov. Abigail Spanberger warned Tuesday.
By the numbers: Richmond-area ER visits by patients paying out of pocket or without insurance more than doubled from 21,403 in 2022 to 52,338 in 2025, according to an analysis the Virginia Hospital & Healthcare Association shared with Axios.
- Chesterfield, Henrico and Richmond accounted for nearly 90% of the total number of local ER visits by uninsured patients in that time, VHHA spokesperson Julian Walker tells Axios.
Between the lines: The rise overlaps with an increase in Virginia's uninsured population after pandemic-era protections that kept most Medicaid recipients continuously enrolled ended in 2023.
- Another pressure point: Enhanced federal subsidies that made Affordable Care Act Marketplace plans cheaper expired in December, an effect not yet captured in VHHA's latest data.
Zoom in: The region's major hospital systems aren't saying exactly how much of an increase in uninsured or self-pay patients they're seeing so far this year.
- But VCU Health and HCA Virginia (which includes Chippenham and Henrico Doctors') confirmed to Axios that they're currently seeing a rise.
- And that's before "the most significant Medicaid eligibility changes" kick in, says VCU Health spokesperson Leigh Farmer.
- Bon Secours referred Axios to VHHA.
The big picture: H.R. 1, the Republican-backed tax and spending law President Trump signed last year, seeks to rein in federal Medicaid spending through a series of funding and eligibility changes.
- Republicans have framed it as a way to reduce improper enrollment and push more Medicaid recipients to work.
- Starting Oct. 1, about 5,800 Virginians could lose Medicaid as the law eliminates eligibility for certain lawfully present noncitizens, such as some refugees, Afghan visa holders and trafficking survivors.
- In January, Medicaid expansion adults will face eligibility checks every six months and, with some exceptions, will have to document 80 hours a month of work to maintain coverage.
Threat level: Spanberger's administration estimates nearly 300,000 Virginians are at risk of losing coverage under the new work requirements, including 41,602 in the Richmond area, per a newly launched dashboard documenting the effects.
- Some could remain eligible but lose coverage because they missed paperwork or reporting deadlines, Virginia health secretary Marvin Figueroa said Tuesday.
- And Spanberger, who issued an executive order Tuesday aimed at keeping eligible Virginians enrolled, warned more coverage losses could push people to delay routine care until they end up in ERs.
What's next: Asked by Axios whether Virginia would help hospitals absorb those additional costs, Spanberger pointed to the state's efforts to keep people insured in the first place, including $150 million in state-funded Marketplace assistance.
- Figueroa said the state is also working with free clinics and community health centers on their capacity to absorb more uninsured patients.
- But he acknowledged that "they're not prepared to be able to take on as many people as we predict are going to be uninsured."