Admin_Adham
When the Affordable Care Act’s (ACA’s) subsidy credits expired at the end of 2025, physicians knew patient volume — and overall revenue — would be drastically affected.
Indeed, a $5.1 billion loss in revenue for office-based physicians is projected for this year, according to data from the Robert Wood Johnson Foundation.
And, while patients’ need for medical care hasn’t changed, the volume of paid visits has already begun shifting toward either uncompensated care or those visits have been deferred entirely.
Eleonora Fedonenko, MD, an internist and dermatologist in Los Angeles, has already seen the ramifications of Congress’ failure to reach a healthcare deal late last year.
“Many of my patients are part-time, self-employed, or gig employees who rely on ACA subsidies to afford insurance,” Fedonenko said. “To lose the financial assistance provided through the ACA is not an abstract policy issue. It is real to my patients.”
While other specialists will certainly be affected, primary care physicians (PCPs) are likely to carry the biggest brunt of the 4.8 million Americans projected to lose coverage.
“This affects them as well as those doctors who aren’t in concierge or special cash-only practices,” said Carl Law, MD, an anesthesiologist in San Jose, California, and founder of Doctors First Staffing, which matches physicians with trusted healthcare facilities across the US. “They’re either not seeing patients on a regular basis, or they’re seeing them at a late stage of illness.”
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, Medscape’s State of Primary Care in the US Report 2026 found that:
- The PCPs surveyed were critical of the overall health of primary care.
- Surveyed PCPs worry about patient accessibility, including backlogs on appointment calendars, health insurance affordability, and cutbacks to the ACA.
- 44% gave primary care a “C” grade when it comes to patient care.
Jason Schroder, MD, a board-certified anesthesiologist in Tulsa, Oklahoma, said he’s already seen a 30% reduction in patient volume.
“This has led to us being continually forced to make hard decisions on staffing and capital purchases due to the gaps in revenue related to the lack of patients coming to our practice.”
He added that while cash-based models offset some of the revenue lost from premium tax credits or other reimbursement reductions, they also limit the number of patients who can enter through our doors each day.
Ultimately, this ACA cliff is going to continue to strain the system.
“When someone skips an appointment, doesn’t take their blood pressure medication, or can’t afford it and goes to the hospital because they’ve had a stroke, all of this becomes more costly for everyone,” Law said.
In other scenarios, a skipped scan can mean a worse prognosis.
“I’m thinking of one man who delayed his CT scan for several months and, when he finally came in, we discovered that his cancer had doubled in size,” Schroder said. “The emergency room has become the ‘go-to’ place for patients whose conditions could have been treated much earlier and far less expensively. Watching people trade a scan today for a crisis tomorrow is what stays with me.”
Fedonenko said her biggest concern is that patients who need ongoing care are skipping appointments.
“Patients I’ve known for years are calling to reschedule, not because they feel better but because healthcare lost the round,” she said. “The deferral patterns this time are different from the disruptions of the past in that these aren’t people avoiding elective visits. They’re actually the ones who aren’t doing follow-ups for conditions that need to be monitored actively.”
Waiting until this situation on Capitol Hill shakes out doesn’t portend well for these patients.
“In my experience, many of the patients who choose to delay coming back to see me are the ones who have the largest issues requiring that follow-up visit,” Fedonenko said.
Patients Find Their Way to a Plan B
For now, Amar Rewari, MD, chief of radiation oncology at Luminis Health in Maryland and an adjunct assistant professor of radiation oncology at Johns Hopkins University School of Medicine in Baltimore, is addressing revenue shortfalls by prioritizing three key areas.
“We’re strengthening financial navigation upfront so patients understand their coverage options and can be connected to assistance programs early,” he said. “We’re tightening revenue cycle processes to reduce denials and delays, particularly as payer mix shifts, and we’re being more deliberate about care pathways and site-of-service decisions to manage costs without compromising quality.”
Christopher Jimenez, MD, a board-certified hip and knee replacement surgeon in central Texas, who runs a multi-location orthopedics practice, is compensating for this volume shift by tightening same-week access so patients don’t drop off while shopping for health plans.
“We’re also pushing definitive imaging to the first visit when appropriate and leaning into conservative options that are high value when coverage is shaky, such as targeted PT protocols, activity modification, anti-inflammatories, and image-guided injections rather than ‘wait it out and come back worse.’”
In fact, imaging itself is critically affected by downgraded ACA coverage, said Seth Crapp, MD, a double board-certified radiologist in Miami who runs a teleradiology group for outpatient centers and hospitals across multiple states.
“One of our partner sites saw a noticeable drop in screening/‘rule-out’ outpatient CTs and a simultaneous increase in ED [emergency department] CTs and appendicitis rule-outs,” he added. “We adjusted staffing to add an extra evening radiologist block and pushed tighter critical-result escalation, so surgeons and ED physicians weren’t waiting. That kind of shift doesn’t just change volume — it changes turnaround expectations, staffing, and malpractice exposure. This is why the subsidy cliff matters to every physician — even if their waiting rooms don’t look empty.”
When forecasting what the year ahead will bring, Rewari said he’s worried most about how the ACA cliff affects his patients’ overall health.
“We’re already seeing patients presenting later in the disease course when conditions are more advanced and are more expensive to treat,” Rewari said. “We’re also experiencing an increase in administrative complexity. We’re spending more time navigating coverage gaps, prior authorizations, and financial counseling — rather than focusing purely on clinical care.”
The sources in this story reported having no relevant disclosures.
Lambeth Hochwald is a New York City-based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at New York University’s Arthur L. Carter Journalism Institute.
