Health Systems Reported Declines in Elective Care
Hospitals face surgery volume drops as coverage changes and rising costs deter patients from seeking procedures.
Updated on Sept. 22, 2026 in Healthcare
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Major U.S. health systems report significant declines in elective surgeries as patients navigate the loss of enhanced Affordable Care Act premium tax credits. The shift has left hospitals struggling with rising costs and lower procedure volumes nationwide.
Why it matters
The expiration of federal subsidies has forced many patients to move to lower-tier plans or become uninsured, leading them to defer non-emergency medical care due to higher out-of-pocket costs.
HCA Healthcare reports a 2.3% drop in same-facility inpatient surgeries and a 3.4% decline in outpatient procedures for the second quarter of 2026. Additionally, approximately 300,000 Arizonans have lost health coverage year over year.
The players
HCA Healthcare
Based in Nashville, Tennessee, this is one of the largest health systems in the United States.
Banner Health
This Arizona-based nonprofit health system operates hospitals and clinics across several states.
The details
Health systems are increasingly connecting patients with financial assistance programs and expanding access to ambulatory surgery centers to mitigate the impact of declining elective volume. Despite these efforts, HCA elective inpatient procedures dropped 6% during the second quarter.
Timeline
Enhanced ACA premium tax credits expired at the end of 2025.
Banner Health leadership identified coverage pressure in January 2026.
HCA Healthcare recorded surgery declines throughout the second quarter of 2026.
HCA executives discussed the financial impact on September 15, 2026.
Market Landscape
This contraction in elective care follows the sunsetting of the Affordable Care Act premium tax credits, which previously buffered patients against rising costs. Health systems now compete for a shrinking pool of patients who can afford out-of-pocket expenses while contending with a shifting insurance payer mix.
Patients may find it increasingly difficult to schedule non-emergency surgeries as hospitals adjust internal financial assistance policies to handle rising costs. If you are facing coverage changes, you should contact your provider directly to inquire about internal payment plans or available charity programs.
The takeaway
Patients navigating the current insurance environment should prioritize communication with hospital financial counselors before deferring necessary procedures. Providers are actively retooling their access points, meaning that patients who ask about financial support may still find options for care.
Further reading
For more on the current state of the industry, see the Healthcare section.
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