CHARLOTTESVILLE, VA (CVILLE RIGHT NOW) – A new analysis by the Virginia Hospital and Healthcare Association found the number of people self-paying for ER visits in Virginia’s hospitals in 2025 was up sharply from what it was in 2022.

The number of people who did not have insurance or presented no proof of insurance who visited emergency rooms in 2025 was a four-year high of 405,584, according to a survey of hospitals across the Commonwealth.

That number was up 49% from 2022, when 272,185 ER visits were classified as self-pay.

“That is occurring before the effects of H.R. 1, the Budget Reconciliation Legislation of 2025 known as the one Big Beautiful Bill, before the effects of that take place,” VHHA spokesman Julian Walker told Cville Right Now. “And the effects of that legislation cut Medicaid funding by nearly a trillion dollars over a decade.

“What we’re sharing in this data is that even before we start to see the significant losses of coverage that are projected from H.R. 1, we’re already seeing an increase in Virginia hospitals of patients who are self-paying.”

Overall, Virginia’s ER volume has increased by 11.3%, from 3,568,598 visits in 2022 to 3,970,960 in 2025.

Over that four-year span, Virginia hospitals recorded more than 1.35 million self-pay ER visits, accounting for nearly 10% of all emergency department encounters.

Not only is the number of uninsured patients expected to increase when the new legislation goes into effect, Walker said annual funding to Virginia hospitals are expected to fall by more than $7 billion.

Walker said one of the factors in this drop was, as part of the COVID relief packages, Congress implemented more subsidies for people to be able to stay on their insurance plans through the Affordable Care Act marketplaces. Those subsidies are now set to end.

Resultantly, a significant number of people did not renew plans. Walker said VHHA’s is not the only data indicating this.

“The Virginia Healthcare Foundation does an annual assessment of the number of uninsured Virginians,” Walker said. “And their assessment from last year showed that Virginia had hit its lowest uninsured rate in more than 30 years of them doing that study.”

As for hospitals, a few have had to close their doors but most have found creative ways to remain financially viable.

Walker said time could run out as H.R. 1 is fully implemented over time.

Increases in uninsured rates historically have led to more patients self-paying, leading to increased charity care and bad debt for hospitals, as well as higher insurance costs for workers and businesses.

VHHA reported that in 2024, Virginia hospitals absorbed a nearly $1.4 billion Medicare shortfall, meaning the gap between Medicare reimbursement and the actual cost of providing care. That same year, $457 million in charity care was provided by Virginia hospitals, which also incurred $428 million in bad debt from unpaid bills.

At the same time, Walker said he would expect impacts on insured people as employee health insurance premiums are likely to increase as more people are uninsured and unable to pay.