American Hospital Association CEO Rick Pollack interview: Medicaid, changes in Washington, and stepping away

Even though he has announced his intentions to step away, Rick Pollack doesn’t sound as if he’s letting his foot off the accelerator.

Pollack, the president and CEO of the American Hospital Association, said in December that he plans to retire this year. He has led the association for a decade and spent more than 40 years with the organization. The association continues its search for his successor.

In an interview with Chief Healthcare Executive® last week, Pollack showed he’s thoroughly engaged with top priorities and policy issues for hospitals. But he also says he’s ready for a little more free time and he thinks the hospital association will benefit from new leadership.

“There's a time and season for everything,” Pollack says. “And I've come to the conclusion that it's time to let someone else have a chance at leading this great field.”

In a wide-ranging discussion, Pollack discussed the budget package President Trump signed last week, the impact of Medicaid cuts, the loss of enhanced tax credits for the Affordable Care Act, and rapid changes in Washington.

He also says health systems are looking at reducing services, and said some may have to close without changes in federal policy.

(See part of our conversation in this video. The story continues below.)

‘All about coverage’

The president and White House avoided a protracted government shutdown with a $1.2 trillion spending package, which included some big priorities for hospitals. The budget deal includes extensions for Medicare programs supporting rural hospitals.

Health systems also finally secured a multi-year extension of Medicare waivers for telehealth programs, including a two-year extension for telehealth programs and a five-year extension for hospital-at-home programs.

Pollack said the telehealth extensions are vital to hospitals. He said the extension of hospital-at-home programs could provide more incentive to health systems who had been interested in launching home hospital programs but were leery of doing so because of uncertainty in federal policy.

“There's no question that people were concerned about the long-term policy in this regard, and you know how unpredictable things could be in Washington in terms of policy,” Pollack says. “And I think a lot of people were waiting to see, is this going to get locked in or not? Now, we were always confident politically that it would … but until it's done, and there's a firm signal, people definitely were taking a wait-and-see attitude.”

The spending deal also averts cuts of billions of dollars to a Medicaid program that supports hospitals with a high percentage of Medicaid patients. The cuts to the Medicaid disproportionate share hospital (DSH) program are now blocked until October 2027. Pollack says preventing further reductions is particularly important, especially with more people expected to lose coverage under the Affordable Care Act.

Hospitals are expecting to see more patients without coverage due to the expiration of enhanced tax credits supporting the Affordable Care Act.

Without those credits, millions of Americans may no longer be able to afford coverage with premiums more than doubling. KFF projects premiums will rise from an average of $888 in 2025 to $1,904 in 2026. Even some who may be able to manage the spike in premiums may opt against spending the money and take their chances with going insured.

Pollack says hospitals are likely to end up treating more uninsured patients.

“It's all about coverage at the end of the day. I mean, we're talking about an increased number of people that are either going to be uninsured or underinsured,” he says.

And he says that likely means more uninsured patients going to emergency rooms for health care needs.

“We are the ultimate safety net where people turn to, and that's going to have a real dramatic impact, not just on the people that are affected by these policies, but on everyone,” he says.

Medicaid cuts

Hospitals have been bracing for big changes in Medicaid programs in the next few years. Health systems are bracing for cuts in Medicaid programs in the coming years due to the HR 1 tax package approved last summer.

The package is expected to cut more than $1 trillion in Medicaid spending over the next decade, with more than 10 million Americans expected to lose coverage. Some may lose coverage when new work requirements for Medicaid programs take effect next year.

Pollack says hospitals will see more people turning to emergency rooms for care, even as they already see more patients who can no longer afford coverage under the Affordable Care Act.

“As a practical reality, they all end up at our ED doors in many ways, and that's not good for not only the patients from a care perspective, but it affects everyone, and not just Medicaid beneficiaries,” Pollack says. “Because when EDs get clogged up, it means longer waiting times for a lot of other folks.”

Reduced services and closures

Even with some of the Medicaid cuts being phased in over time, hospitals and health systems are planning now. Some are looking to work with other partners to try and find ways to keep patients from needing the emergency room.

But some hospitals are taking a look at reducing services due to increased financial pressures with less support from Medicaid programs and an influx of more patients without insurance.

“Some of those changes may be services that simply aren't going to be able to be provided, that might have otherwise been provided, and we're going to have to make adjustments because the reductions are rather substantial,” Pollack says.

Some hospital leaders have raised the possibility that the Medicaid cuts could lead to some hospitals shutting their doors. Pollack says he expects more health systems will look at reducing services rather than shutting down.

But he doesn’t discount the possibility that some hospitals may end up closing due to Medicaid cuts.

Pollack says it’s “more and more likely to see adjustments in terms of the array of services that are provided, as opposed to outright closures.”

But he adds, “There could very well be closures, and we're very concerned about that.”

With Medicaid cuts and changes coming over a 10-year period, Pollack also suggests that there’s a possibility Congress could reverse some of those cuts in the future. Pollack says the hospital association will press lawmakers to prevent cuts to Medicaid.

“It's not unprecedented that Congress comes back when they determine that they've overreached, and they make changes,” he says.

Dramatic change

Having spent decades dealing with federal policy in Washington, Pollack says he’s seen a lot of changes.

But President Trump’s administration has produced sweeping changes in healthcare policy in just over a year, including HR1, also called the One Big Beautiful Bill, the National Institutes of Health terminating grants, the launch of the Rural Health Transformation Program and changes in vaccine policies.

“The one big bill was pretty dramatic, no question about it,” Pollack says. “And then there are a lot of regulatory issues and executive orders and other things that have contributed to a fairly rapid pace of change. You know, you look at what occurred … with regard to Medicaid, you look at the changes in a lot of other areas, ranging from public health to NIH funding to the food pyramid. You know, certainly, the pace of change has been rather dramatic.”

Pollack says the next leader of the American Hospital Association will need to form partnerships to deal with rapid changes in the industry.

“That person is going to have to really focus on solutions, additional solutions, to some of these vexing problems,” he says. “And they're going to have to be focused on creating coalitions among different sectors.”