2025 Healthcare Costs and Policy Issues

When people have trauma or severe physical symptoms, they often head to the nearest hospital emergency department for treatment. Because of that, emergency departments have become the backbone of America’s medical safety net.

However, these EDs are facing severe financial and operational headwinds that could undermine their ability to provide care to millions of patients, according to a newly released report from RAND Corporation, backed by the Emergency Medicine Policy Institute.

The study, which focuses on widening cracks in the current payment structure for emergency care, reveals that declining reimbursements, rising operational costs, and a surge in uncompensated care are pushing many emergency physician groups – particularly independent practices – to the brink of financial instability. If left unaddressed, experts warn, these challenges could result in fewer emergency departments, longer wait times, and reduced access for vulnerable populations.

Rising demands, shrinking payments

Emergency physicians treat all patients, regardless of insurance status or ability to pay, under the Emergency Medical Treatment and Labor Act, a federal mandate. Despite representing just 4% of the physician workforce, they provide nearly two-thirds of all acute care for uninsured individuals.

Yet the economic realities paint a grim picture. Between 2018 and 2022, in-network payments from commercial insurers declined by 10.9%, while out-of-network payments fell by nearly 48%. Payments from Medicare and Medicaid fell by 3.8% during the same period. 

At the same time, 20% of expected payments for emergency care go unpaid, adding up to a staggering $5.9 billion in uncompensated services annually.

“In 2024, ED visit numbers almost reached prepandemic numbers nationally, with a consistent rise between 2020 and 2024,” the authors wrote. “Patient complexity is on the rise, with EDs managing patients with complex medical and social needs.”

Insurers under scrutiny

The report also shines a spotlight on what it describes as “bad payer behavior,” pointing to tactics such as delayed or denied reimbursements and systemic underpayment by insurers. These practices, the authors argue, erode the financial viability of emergency departments and increase the risk of closures or forced acquisitions by larger health systems.

Patrick Velliky, chair of EMPI, warned that unchecked consolidation and insurer misconduct could lead to dire consequences. He warned that these practices threaten the survival of emergency departments and the patients that rely on them for care when it’s needed most.

The U.S. Environmental Protection Agency should ban the pesticide chlorpyrifos on more crops because it is linked to neurological damage, a group of nine attorneys general said Tuesday.

The EPA has already proposed banning chlorpyrifos on 70 crops, but the proposal would allow it on 11 others, including apples, asparagus, citrus, cotton, peaches, soybeans and strawberries.

The ban is still under review and the EPA said an interim decision would come in 2026.

Chlorpyrifos is toxic and linked to neurodevelopmental harms in children, with exposures among pregnant woman causing lower birth weight, reduced IQ, loss of memory, attention disorders and delayed motor development, said the California attorney general, who joined with attorneys general of New York, Hawaii, Maryland, Massachusetts, Oregon, Vermont, Washington and the District of Columbia in filing a comment letter with the EPA.

Acute exposure to chlorpyrifos can cause sweating, salivation, vomiting, low blood pressure and heart rate, seizures and even death, the attorneys general said.

People are exposed to chlorpyrifos through food residues, drinking water contamination and drifts of agricultural sprays, the attorneys general said.

“The facts are clear: chlorpyrifos exposure poses a grave danger to a child’s health," California Attorney General Rob Bonta said. "This pesticide has no place in our food systems."

California has already banned chlorpyrifos on all crops, but Bonta said the health of its residents are threatened by imports of crops sprayed with the pesticide.

Email Dieter Holger at dholger@consumeraffairs.com.

Calls to poison control centers among youth because of energy drinks have surged recently.

There was a 35% increase in calls to poison centers fearing overdoses from energy drinks for people younger than 20 from 2011 through 2023, according to a study by researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center, published in the the Journal of Medical Toxicology.

And there was an alarming 633%, or more than seven times, increase in calls after youth consumed powders that mix into liquid to create energy drinks, the researchers said.

"Because of unclear dosing instructions or preparation errors, overdose can occur," said Hannah Hays, co-author of the study and medical director at the Central Ohio Poison Center. "Concentrated powder or granules may also be mistaken by a young child as a food item."

Most calls were among children younger than six at 70% and males at 57% among all caffeine-energy products, which included energy drinks, powders and solids, such as capsules, the researchers said.

“The high and increasing rate of exposure in this vulnerable age group indicates that caffeine energy products are accessible and attractive to young children,” Hays said. “Caffeine energy products should not have packaging that is appealing to young children and should be kept out of the sight and reach of young children.”

Still, 81% of calls didn't result in treatment at a medical facility and only 1.6% of cases were admitted for treatment, the researchers said.

But the researchers said teenagers aged 13 to 19 years old were more likely to need medical attention.

How can parents protect kids from energy drinks?

The researchers have recommendations for parents who want to keep their children safe from caffeine products:

• Talk with children: Have age-appropriate conversations with children about caffeine-energy products, explaining what these products are and why they can be dangerous. Review labels together so everyone understands what’s in the products. The American Academy of Pediatrics recommends that children and teens don't consume energy drinks.
• Store safely: The best way to keep children safe from caffeine energy products is to keep them out of the home. If these products are kept in the home, store them in a safe place away from your children—stored up and out of sight, away from food and locked, if possible. Ask that caregivers around children do the same in their homes.
• Don’t use in front of children: It is helpful to never use these products in front of children, especially if packaged to look like treats.
• Keep the national Poison Help Line handy: Have the number for stored in phones and posted in a visible pace. The national Poison Help Line can be reached 24 hours a day, seven days a week at 1-800-222-1222. 

Email Dieter Holger at dholger@consumeraffairs.