Public Law 119-21 Will Cost Hospitals $68.6 Billion. Here’s What CFOs Should Do Now.
Premier has put numbers behind what many hospital finance leaders have been sensing for months.
According to new analysis, Public Law 119-21 is projected to reduce U.S. hospital revenue by $68.6 billion over 2026 and 2027, driven by coverage losses tied to changes in Medicaid eligibility and marketplace subsidies.
This is not a marginal adjustment.
It is a structural shift.
Where the losses come from
Premier’s breakdown is especially important because it shows where the damage concentrates:
• -$33.6B in commercial revenue
• -$22.4B in Medicaid revenue
• +$12.5B increase in uncompensated care
That mix matters. Hospitals have long relied on commercial margins to offset public-program underpayment. Public Law 119-21 weakens that buffer at the same time uncompensated care rises sharply.
How bad could it get?
Most hospitals are projected to experience 2–10% net patient revenue contraction. Some may exceed 20%.
Even the largest health systems are exposed. Premier estimates that systems with NPR over $5 billion could see losses ranging from -$58 million to nearly -$1 billion.
Scale does not equal immunity anymore.
Why timing is the real risk
Premier expects many of these effects to hit in early 2026, when patients losing coverage begin deferring care or shifting to uninsured status.
That timing is critical. Revenue declines will arrive before most organizations can:
• Adjust labor models
• Redesign patient financial workflows
• Secure philanthropic offsets
• Rebuild capital plans
Hospitals that wait for confirmed volume declines will already be behind.
This was forecastable
In RCM 2030: Strategy and Survival for Revenue Cycle Leaders, I warned that policy-driven coverage churn would become one of the most dangerous revenue cycle risks of the decade.
Premier’s analysis confirms that warning with national and state-level data.
This is not about ideology.
It is about math.
What CFOs should do now
If leadership teams aren’t already acting, Premier’s data suggests immediate focus on:
Pressure-testing payer mix exposure under 2026 assumptions
Modeling state-specific risk zones, not national averages
Accelerating front-end financial assistance screening to blunt uncompensated care growth
Reevaluating capital plans assuming 5–15% NPR contraction
Diversifying revenue streams beyond traditional inpatient dependence
The bottom line
Public Law 119-21 will not hit all hospitals equally. But it will hit nearly all of them.
Hospitals that treat this as a future problem will experience it as a crisis.
Hospitals that model it now can still shape the outcome.
Premier’s full analysis is worth reading in detail here: https://premierinc.com/newsroom/blog/premier-data-shows-obbba-will-trigger-a-68-billion-hospital-revenue-impact
