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Last year's spending bill is expected to reduce Medicaid funding "by nearly $1 trillion over 10 years," and KFF Health News reported on Montana's challenges in sustaining Medicaid. They plan on enforcing the federal government's work mandate, which will curtain some enrollment. One idea is "to withhold a 3% Medicaid provider rate increase approved by the legislature and governor last year," but "Health organizations have pushed against the plan, saying that Montana's Medicaid payments already don't cover the cost of care and that health businesses can't afford wages that attract workers." The head of one nonprofit said that his organization "has more than 70 group-home beds it's been unable to fill, because it's down roughly 15% of its workforce." Another leader at a provider organization indicated that "low reimbursement rates can hurt their patients who need care elsewhere, as more healthcare providers decide they can't afford to accept Medicaid."

Reducing or stagnating provider reimbursement might seem like an easy option to stretch funding, but can lead to unintended consequences that make it difficult for patients to access care. At the same time, reducing benefits or coverage would also make it more difficult for patients to receive care.

With the rise in Affordable Care Act insurance premiums (and that "subsidies that help people purchase coverage shrank or vanished"), KFF Health News reported on the drop in enrollees who paid their premiums, citing one news source as saying that "roughly 21% of people using the federal ACA marketplace ... failed to pay their share of January premiums, which, if correct, is far higher than at the same time last year." In addition to rising premiums, "the average ACA plan deductible saw the steepest increase in history — growing by 37%, or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired." One consulting group "estimates that average ACA enrollment will end up being 17% to 26% lower this year than last."

With the effective premiums rising as much as they are, it is not surprising that many people choose to skip paying for insurance. Since healthier people might be more likely to forgo insurance, a drop like this can lead to higher premiums for the remaining enrollees, which could trigger spiraling prices. One consultant noted that these drops in enrollment "are real people with real consequences."

Non-profit organizations are supposed to provide community benefit in exchange for not having to pay taxes, and as such, hospitals frequently provide charity care for the indigent. However, KFF Health News paints a picture of how some such organizations in Minnesota try to minimize their obligation when law and regulations are vague. For one, some hospitals or health systems seem to make it difficult to find information online about charity care. For another, "some hospitals give free care to patients with an annual household income of $47,000, while others cap it at about $15,000" -- which seems like a very low ceiling when an out-of-pocket maximum might be around $8,000 or a procedure might be "more than $19,000." Overall, the hospitals in the state spent about 0.8% off their operating budgets on charity care, about a third of the national average.

While the chief executive at one medical center is quick to point out that "many health insurers post billions in profits," the underlying cost of care is still a major issue. Diverting more and more of insurers' profits while not doing anything to address the cost of care seems to not be a winning strategy.

With campaign season for California's governorship underway, several candidates have been declaring support for single-payer health care. From KFF Health News' article about the situation, it appears many Democratic candidates see it as a way of remaining competitive in the primary. KFF Health News previously published an article on the outgoing governor's campaigning on single-payer health care, only for that campaign promise to not materialize, with one director of a nurses' organization saying that the governor "pulled a bait and switch on Californians, purposely mixing up universal healthcare with single-payer."

Apparently, the state projected that single-payer health care would cost the state over $500 billion a year, which dwarfs the state's annual budget of around $350 billion. It is true that taxes could be raised, Medicare and Medicaid funds might be applied differently, and current premiums be redirected, but even aside from the funding question, the logistical challenges of proposal seem daunting. Notably, the only state to have passed single-payer health care (Vermont) ended up reversing course. Perhaps citizens would be better served by candidates who are willing to address underlying reasons for the expensive costs of health care, rather than following candidates who promise single-payer solutions.

People know that visits to emergency rooms can be expensive, but KFF Health News detailed the interactions within one particular visit and the associated cost. The patient understandably felt that "Paying $3,100.24 for literally sitting in the ER entertaining my kids for an hour and a half feels kind of incredible." (The patient's insurance covered more than that amount, with the total billed amount as over $6,700). On the other hand, it is unclear what the visit should have been priced at.

A big part of the problem is that emergency rooms are... for emergencies, meaning that they must be staffed for what might happen, not what will happen. With salaries of medical professionals being as high as they are, it is understandable that ER visits would need to cover the unused capacity and would therefore cost more than what a member of the general public might expect. There is also the element of the hospital being compensated for specific knowledge rather than actual work (a matter of "knowing where to hit the hammer").

At the same time, it appears that the patient received very little "active care" from the hospital (the patient spoke to the doctor "for no more than five minutes"). Additionally, it appears that the patient might not have been charged more even if she required some more medical attention than simply being monitored, although it seems likely that in that case, the hospital would have found new billing codes to apply. With visits so unpredictably expensive, it is not difficult to imagine patients trying to avoid the emergency room, which is probably not in the public interest.

Perhaps an alternative billing structure would be for the insurance plans of nearby patients to pay a fixed monthly fee per patient to sustain the emergency room. Emergency rooms would then have more steady revenue, and patients could then be charged less for each visit. Patients with non-participating insurance plans would be charged substantially more. Practically, such an arrangement could introduce some complexities in terms of how insurers would determine which emergency rooms to support for their patients. While this arrangement is probably better for patients, it is unclear how insurers would regard such a proposal.