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…