Who pays when someone without insurance shows up in the ER?

The question is important as Republicans debate health care legislation that could result in more than 20 million fewer Americans having health insurance in ten years. If that happens, some people will go without care. Others will show up at hospitals, but won’t be able to pay their bills.

It also doesn’t mean that hospitals won’t try to bill someone without insurance. And the bill they send will be higher than for an insured patient because there’s no carrier to negotiate lower prices.
As a result, the uninsured are more likely to be contacted by collection agencies, as they face problems paying both medical and non-medical bills. One study, published in 2016 by the National Bureau of Economic Research, found that someone who goes into the hospital without insurance doubles her chances of filing for bankruptcy over the next four years.
For the bills that go unpaid, hospitals can try to compensate by charging other patients more. But that doesn’t happen as much as many people – including policymakers -- think.

Studying the effects of expanding Medicaid in Michigan – where more than 600,000 gained coverage – researchers at the University of Michigan have found no evidence that the expansion affected insurance premiums. They did, however, document that hospitals’ uncompensated care costs dropped dramatically – by nearly 50%.