Essential hospitals face ‘an existential crisis’

Since taking over as president and CEO of America’s Essential Hospitals a little more than two months ago, Jennifer DeCubellis has heard two similar messages.

She says she has received hearty congratulations and expressions of appreciation for taking the role at a difficult time.

DeCubellis leads the nonprofit group representing nearly 400 safety net hospitals across the nation. She succeeds Dr. Bruce Siegel, who retired after leading the organization since 2010.

As she tackles her new role, DeCubellis doesn’t mince words about the sobering financial landscape for hospitals that serve populations with lower incomes. She tells Chief Healthcare Executive® that changes in federal policy and looming Medicaid cuts threaten the future of essential hospitals.

“Hospitals are the backbone of health care,” DeCubellis says. “If you look at our numbers … It is an existential crisis right now.”

DeCubellis offers compelling data on the importance of essential hospitals. While they represent only 6% of the nation’s hospitals, they provide 29% of uncompensated care delivered by hospitals nationwide.

Essential hospitals provide 43% of the nation’s burn care beds, and 31% of America’s level one trauma units.

“When health care starts failing, when policies start failing, people turn to essential hospitals to say they're always going to be there,” DeCubellis says. “And the worry right now is, are they always going to be there?”

Scaling back services

DeCubellis has a new role but she’s not a newcomer to the organization, serving as a board member. She also served as the CEO of Hennepin Healthcare System in Minneapolis.

At Hennepin, she said nearby hospitals shut down some services, including maternal health and pediatrics. Hennepin expanded services, but DeCubellis recalls talking to the board about the need and the challenge, since other providers are scaling back services because they are too costly.

Essential hospitals have always responded when there has been a crisis, she says.

She warns that critical services could be lost, with the most vulnerable paying the price.

Some hospitals and health systems that have solid financial margins are scaling back services, which DeCubellis says is a “red flag.”

“More and more maternal health units are shutting down, more pediatric, even ambulatory and outpatient clinics. There's some very healthy health systems that are shutting down their outpatient facilities," she says.

With more financially sturdy systems making those types of decisions, the pressure only mounts for safety net hospitals.

“If more and more health care systems are having to make the hard choices to not rush in when there's a crisis because they can't afford to, we need people's attention to say, this is serious,” she says. “I know when I've had a loved one in a trauma. I wanted to know that my local trauma hospital was open and available and that they could get in. And I think that's what we all want.”

‘Do we keep hospitals open?’

Health systems are bracing for the fallout of the legislation known as “HR 1,” which includes provisions that will lead to significant cuts in Medicaid programs. Hospitals have warned that looming Medicaid cuts will lead to more people without insurance, and hospitals caring for more patients with no ability to pay.

Those changes will affect most hospitals, but some safety net hospitals could be at risk of closing their doors.

“More and more hospitals and healthcare systems, in particular, essential hospitals, are in trouble right now,” DeCubellis says.

“So before those cuts even happen, people are having to make the hard decisions,” she says. “Do we keep hospitals open? Do we keep all of our hospitals open? Do we have to have people drive further? Are there critical services, mental health, addiction, maternal care, pediatric care, that we have to look at differently?”

Essential hospitals provided $11 billion in uncompensated care in 2025, and that figure is projected to rise by $1.7 billion in 2026, DeCubellis says.

With most essential hospitals running in the red already, she worries that additional financial stress may put some at risk of closure. Essential hospitals have operating margins, on average, of -7% this year, the organization says.

As DeCubellis says, “That’s unsustainable.”

With estimates of more than 10 million Americans losing Medicaid coverage in the next decade, DeCubellis says hospitals will be seeing more people coming to hospital emergency departments for treatment. And if they haven’t been able to receive care, they likely will be showing up in hospitals with more advanced conditions, she says.

“If we're removing health care access, we're going to have more people in crisis,’ DeCubellis says.

“If you talk about more people needing emergency care because they're not getting that early prevention intervention, they're not getting access to medications that will keep them stable, all of those are real concerns that we have to grapple with,” she adds.

She says she understands the need to be prudent with taxpayer dollars, and she recognizes the Trump administration’s stated desire to be sure money is going where it should in health care.

“I think everybody aligns with the administration on fraud, waste and abuse,” she says. “Nobody wants to see it in health care. But we need really focused strategies on, how do you get rid of those without collapsing health care at the same time?”

‘These resources can’t go away’

Essential hospitals are also anxious about the possible expiration of tax credits supporting the Affordable Care Act. If the tax credits aren’t renewed, millions may no longer be able to afford coverage due to rising premiums. The White House and congressional Republicans are working on alternatives, while Democrats are urging for the tax credits to be extended.

If the enhanced tax credits lapse, KFF has estimated that those looking to enroll on the marketplace will see premiums more than double, rising by 114%, on average.

If more patients end up without insurance, they won’t see doctors if they’re sick, or they’ll end up in a hospital.

“So the potential is, you see more people without insurance, they go into a self-pay bucket, and if they don't have the ability to pay again, they delay care,” DeCubellis says.

“Smart government is about spending the least amount of money the smartest way possible,” she continues. “Keep people healthy, avoid the deep end services when we can, and these policy changes aren't helping us do that.”

Even as she acknowledges a difficult road ahead, DeCubellis says she is optimistic, by necessity.

She points to Harborview Medical Center in Seattle, which is part of UW Medicine. The system’s trauma center, pediatric trauma unit and burn center serve the Seattle area, along with patients in Montana, Idaho and Alaska. Other safety net hospitals provide services for their home cities, surrounding counties, and other states.

“It's imperative we figure it out. These resources can't go away,” DeCubellis says.

“We need to be optimistic, or you don't stay in the work, and you need to keep fighting and battling,” she continues. “And it's not about the fight, it is about the problem-solving. It's, how do we bring solutions forward? Because I do think we're aligned as a nation about what we need. How do we get there?”