RICHMOND, VIRGINIA — Emergency department visits by uninsured patients increased 8% at Virginia hospitals during 2025, raising concerns that coverage losses are shifting more medical care into costly emergency settings.
The Virginia Hospital and Healthcare Association classifies these visits as “self-pay,” meaning patients lacked insurance or could not document coverage when treated. Emergency rooms must evaluate and stabilize patients regardless of their ability to pay, leaving hospitals to absorb unpaid costs or recover them through other revenue.
Visits involving Medicare, Medicaid and private insurance remained comparatively stable or recorded only modest increases. Meanwhile, Virginia’s insurance marketplace has lost more than 67,400 enrollees compared with the same period last year, according to the State Corporation Commission.
State lawmakers approved additional assistance for free clinics and federally qualified health centers, along with a state insurance subsidy expected to help approximately 200,000 residents. Enrollment for that assistance begins in November.
Hospitals are also preparing for stricter Medicaid work and eligibility-verification requirements scheduled to begin in January. Healthcare officials warn that rising uncompensated care could lead systems to reduce staffing, close outpatient services or negotiate higher payments from private insurers. A state report has identified 13 rural Virginia hospitals as financially vulnerable, although industry representatives said immediate closures are not inevitable.
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