Recent federal budget cuts signed into law by President Donald Trump are set to impact healthcare access significantly. Over the next decade, the Congressional Budget Office projects that approximately 12 million individuals may lose Medicaid coverage, with an additional 5 million potentially losing Obamacare insurance due to policy changes. These cuts could lead to hundreds of thousands skipping preventive screenings and around 2 million losing their primary care providers, creating unprecedented challenges in healthcare access.
The loss of a trusted primary care provider can deepen patients’ distrust in the medical system, often resulting in delayed care, worsening chronic conditions, and missed diagnoses. “It’s incredibly disruptive,” said Danielle Ofri, MD, PhD, a primary care internist at Bellevue Hospital in New York City. “It’s soul-crushing for a physician to tell a patient they can’t continue their care for reasons beyond their control.”
Despite these challenges, physicians can play a critical role in guiding patients through this transition by offering practical support and resources.
Start the Conversation About Coverage
Physicians should proactively discuss the potential loss of insurance with their patients, advises Sarah C. Nosal, MD, FAAFP, a family physician and president-elect of the American Academy of Family Physicians. “This isn’t about politics—it’s about health,” Nosal emphasizes. These conversations, though uncomfortable, are essential to prepare patients for upcoming changes.
Empathy is key. “Acknowledge how stressful this situation is for patients,” says Ada Stewart, MD, a family physician in Columbia, South Carolina, and past president of the American Academy of Family Physicians. Drawing from her experience in a state that didn’t expand Medicaid, Stewart stresses the importance of welcoming patients back without judgment, even if their health has declined due to lapses in care.
Maximize Care Before Coverage Ends
For patients facing imminent loss of insurance, doctors should prioritize accessing as much care as possible while coverage is still active. “Ensure patients are up-to-date on preventive measures, as these can be costly without insurance,” Nosal advises. This includes scheduling mammograms, colonoscopies, pap smears, blood work, and age-appropriate screenings, as well as ensuring vaccinations are current.
For those with chronic conditions, physicians should encourage patients to fill prescriptions for the longest duration their insurance allows. Additionally, doctors can guide patients to research pharmacies, including online options, that offer discounts on medications for out-of-pocket payments.
Clear and accessible medical records are also critical. “Don’t make patients jump through hoops to get their records,” Ofri says. She recommends providing printed copies of medication lists, test results, and after-visit summaries from the past five visits. Nosal echoes this, noting she routinely prints summaries, medication lists, and test results like ECGs, encouraging patients to maintain a physical file of their records in case digital access is limited.
Connect Patients to Resources
Physicians and clinics can help by directing patients to resources for the uninsured, such as federally qualified health centers or sliding-scale services. “Medical practices should compile lists of free or affordable care options to provide direction,” Ofri suggests, noting that this responsibility should ideally fall to state medical associations rather than individual doctors.
In some regions, like New York City, government health systems are developing resources for Medicaid patients at risk of losing coverage. Clinicians can assist by helping patients verify eligibility for aid and navigate bureaucratic processes, such as filling out applications. However, Stewart cautions that these efforts can strain practices. “Supporting patients through this takes time away from direct care, impacting both quality and practice operations,” she says.
Ethical Responsibilities in a Flawed System
The American Medical Association’s code of ethics underscores physicians’ duty to ensure care continuity. For acutely ill patients, Ofri recommends providing pro bono care temporarily until alternative arrangements are made. However, she acknowledges, “Relying on pro bono care is a Band-Aid, not a solution, for a deeply flawed system.”
By initiating open conversations, maximizing care before coverage lapses, and connecting patients to resources, physicians can help mitigate the impact of these cuts. While the road ahead is challenging, these steps can empower patients to navigate an uncertain healthcare landscape with greater confidence.