As the healthcare landscape faces seismic policy shifts under the new administration, hospitals stand at a critical crossroads.
Nicole Stallings, President and CEO of the Hospital and Healthsystem Association of Pennsylvania, joined the Becker's Healthcare Podcast to shed light on the challenges ahead — chief among them, the battle to protect Medicaid.
With 3.2 million Pennsylvanians relying on the program, potential funding cuts could send shockwaves through hospitals, communities and the state's economy. In this conversation, Ms. Stallings unpacks the policy noise, outlines the stakes for hospital leaders, and shares how advocacy can shape the future of healthcare access.
Editor's note: This is an excerpt from an episode of the Becker's Healthcare Podcast. Responses are lightly edited for length and clarity. Click here to listen to the full episode.
Question: With the new administration, what are the biggest healthcare policy shifts hospitals should be preparing for? With so many moving parts, how are you advising hospital leaders to stay informed and on top of potential changes?
Nicole Stallings: We're very focused on protecting and preserving Medicaid. Pennsylvania is an expansion state, with 3.2 million residents currently covered by Medicaid. If expansion were rolled back, projections indicate Pennsylvania would see the fifth-largest increase in uninsured residents nationwide. Beyond the immediate rise in the uninsured population — leading to delayed care and poorer health outcomes — we would also see a significant financial impact. Estimates suggest uncompensated care costs could rise by 25% to 30%, ultimately driving up healthcare costs overall.
These Medicaid proposals could have devastating consequences for healthcare delivery. While Pennsylvania doesn't have public hospitals, we do have hospitals where Medicaid accounts for half — or in some cases, up to 69% — of net patient revenue. Cuts to Medicaid wouldn't just reduce access to care; they could financially cripple hospitals, forcing service reductions or even closures. That impact would then ripple across communities, affecting jobs and economic stability.
What we've been emphasizing to our congressional delegation is that protecting Medicaid isn't just about coverage for the 3 million Pennsylvanians who rely on it — it’s about maintaining access to care for entire communities. However, Medicaid is just one of many issues currently being debated in Washington. Our role as a hospital association is to help our members distinguish between true policy signals and political noise, ensuring they have clear avenues to share their stories with lawmakers.
We know that maintaining access to care is a bipartisan priority, and that's where we're focusing our efforts right now.
Q: Republicans lawmakers said they won't cut Medicaid, yet the Congressional Budget Office reported that it would be impossible for the GOP to achieve its projected $880 billion in savings over the next 10 years without doing so. There's a lot of noise right now, but behind closed doors, are you hearing any specifics about what these potential Medicaid cuts might actually look like?
NS: Any potential Medicaid proposal involves incredibly difficult decisions. I agree — it's hard to see how they reach that level of savings without touching Medicaid. From a healthcare provider perspective, how deep do these cuts go before they hit the bone? And what does that really mean for hospitals and patients?
Right now, our job is to make sure lawmakers fully understand the implications. This isn't just about coverage for Medicaid beneficiaries — there are significant community and economic impacts, both here in Pennsylvania and across the country. We're still early enough in the process that we can keep telling these stories and, hopefully, change some hearts and minds. The alternative would be devastating — not just for healthcare access, but for the broader economy.
Q: What role should hospital leaders and associations play in shaping the conversation around healthcare funding and reimbursement at both the state and federal levels?
NS: We have to tell our story. Very few people outside the industry truly understand the complexities and financial pressures hospitals face. It’s crucial to connect the dots between adequate reimbursement and the ability to sustain the care that communities rely on. Communicating that message is critical, and it must be framed as a shared issue. Hospital stability isn’t just a hospital issue — it's a community issue. You can't have a healthy, vibrant community without a financially viable hospital.
We also have natural allies in this effort. The business community and local governments understand the essential role hospitals play. And because politics are local, hospital leaders are some of our strongest advocates. They are engaged with local businesses and community organizations, they serve on local boards, and they can use those platforms to elevate this issue.
My advice to hospital leaders: Tell the story that only you can tell — how your hospital supports the community, and why adequate funding and reimbursement are essential to that mission. Bring strong allies to the conversation and make sure everyone understands that access to care isn't just a hospital issue — it's a community issue.