HR1 Healthcare Impact

The impact of H.R.1 on ACA exchanges and healthcare coverage

The new tax law reduces subsidies and tightens eligibility requirements for those who purchase health insurance through the ACA marketplace. Some people will lose coverage entirely, while others may find premiums unaffordable. That means more patients showing up uninsured or underinsured. For a health system, that can translate into fewer insured patients, more unpaid hospital bills and a heavier load of charity care.

Medicaid eligibility audits and the impact of H.R.1 on hospital payments

H.R.1 requires states to verify Medicaid eligibility more often. For health systems, this isn’t just about whether a patient qualifies at the start of treatment. Patients can lose coverage mid-treatment or have it adjusted retroactively, which can lead to denied claims or even repayment demands. What might have seemed like a straightforward payment can turn into one with reprocessing, appeals and adjustments. Across thousands of patients, the financial impact can be substantial.

Changes to ACA can threaten coverage and costs

Some insurers are pulling out of ACA marketplaces or scaling back plan offerings, creating less competition and leaving consumers with fewer choices When people lose coverage on the ACA exchanges, either because they no longer qualify for subsidies or because premiums rise too high, they still need care but often can’t pay for it. This can result in more patients paying for services directly, higher out-of-pocket costs, unpaid bills and higher demand for financial assistance from health systems.

Expect more oversight

H.R.1 will also give government agencies more authority to recover overpayments, and hospital systems can expect more audits, more repayment requests and less protection if errors are found. This will cover Medicaid claims, pharmacy invoices and commercial payer reconciliations. And whether there are actual errors or not, things that may have been previously overlooked may now be flagged, creating the potential for repayments and additional financial risk.

How AP recovery audits for hospitals safeguard revenue

While this may paint a bleak picture for the future, regular AP recovery audits can help. While they can’t stop policy changes, they can help a health system reclaim money that’s already been spent or overpaid. An AP recovery audit can dig deep into vendor payments to identify overcharges, duplicate invoices, missed credits and other errors. Every correction is an opportunity to recover funds that might otherwise be lost, putting money back into a health system’s bottom line.

Revenue streams are becoming less predictable, uncompensated care is on the rise and government audits are increasing. Health systems need tools to protect every dollar. Regular accounts payable recovery audits provide a way to recover lost funds and keep finances steady. In the post–H.R.1 environment, AP recovery audits can make a significant difference, helping hospital systems stay ahead of financial risk while navigating a more complex payment landscape.