Marketplace plans from the Affordable Care Act no longer feel very affordable to many people, because Congress did not extend a package of enhanced subsidies that expired at the end of 2025. Last week, the House did pass legislation to extend the expired subsidies, and negotiations have moved to the Senate. Without a deal, an estimated 4.8 million will go without coverage this year.
But even without a health plan, people will still need medical care. Many have been thinking through their plan B to maintain their health.
Donated drugs and sliding scales
Hospitals and clinics are bracing for the influx of newly uninsured patients. They’re also concerned that people won’t know about alternative ways to get medical care.
“We don’t have marketing dollars, so you’re not going to see big billboards or radio ads,” said Katina Beard, CEO of Matthew Walker Comprehensive Health Center in Nashville. It’s one of the country’s 1,400 federally qualified health centers, also called FQHCs.
FQHCs are partially funded by the federal government. Although they do not usually offer free care, their fees tend to be lower or on a sliding scale.
Uninsured people who get care receive a bill, Beard said, “but the bill will be based on their ability to pay.”
FQHCs often have on-site pharmacies, and some offer prescription medications free of charge through a partnership with the Dispensary of Hope, a Nashville-based nonprofit.
Many hospital pharmacies also partner with the nonprofit, which has distributed medication donated by pharmaceutical companies to 277 sites in 38 states. Participating pharmacies must make the medicine available free of charge to people without insurance who have annual incomes below 300% of the federal poverty limit.
The organization primarily sources medications for chronic conditions such as high blood pressure, diabetes, and mental health. Demand is expected to outstrip supply in the new year, according to CEO Scott Cornwell.
“We’re projecting and engaging with our manufacturers and asking them, “Are you willing to help support, for this future status that we are anticipating?'” he said. “By and large,” he said, pharmaceutical companies have said they’re willing to step up.
“It’s a continuous conversation that we’re having,” Cornwell said.
A Medicaid ‘gap’ in 10 states
Hospitals will also have to find a way to care for more patients who cannot pay. Industry groups such as the Federation of American Hospitals have been vocal about the threat to hospitals’ financial health and have urged Congress to extend the enhanced subsidies, which take the form of tax credits.
The impact might be most acute in states like Tennessee that have not expanded Medicaid to cover people who work but do not have job-based insurance and cannot afford it on their own.
Ten states have chosen not to expand Medicaid to uninsured, low-income adults—an optional provision of the ACA that is mainly paid for by federal funds.
This Medicaid “gap” is expected to cause uninsured rates to jump, at the high end of the spectrum, by as much as 65% in Mississippi and by 50% in South Carolina, according to the Urban Institute.
Clinical categories
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