Affordability under pressure: How hospitals are responding to rising patient cost burdens 

When the initial shock of a Stage 4 colorectal cancer diagnosis wore off, Tampa Bay, Florida, resident Tim McDonald, 57, says a new devastation quickly set in: The cost of what it might take to save his life.  

McDonald has been outspoken about his experience in dealing with colorectal cancer and has become a strong advocate for education that empowers individuals to meet the challenges that come with such a diagnosis.^a In a conversation for this article, he recalled, “My mindset was, ‘I’m not going to worry about money. I’m going to put my health first.’ But I also knew realistically, I couldn’t just put my head in the sand and make the costs to go away.” 

Despite changing insurance plans to get better coverage, using personal inheritance funds and leveraging an income-based program that paid 60% of his out-of-pocket expenses, McDonald still found it difficult to afford the care he needed. Over two and a half years, his medical bills (the out-of-pocket costs beyond his insurance coverage) — including monthly premiums, chemotherapy, several surgeries and a liver transplant — would end up exceeding $75,000. 

A patient navigator helped him identify financial resources that would cover some of his costs, and he also spent countless hours of his own time — even while undergoing aggressive cancer treatments — researching financial options.  

“What would I have done if I couldn’t have gotten that transplant?” he said. “I don’t even know if I would still be alive. How many people go through this where they can’t afford a test or surgery and they don’t get the best care possible?” 

Addressing consumer concerns 

More than 1 in 4 adults (28%) responding to the CDC’s National Health Interview Survey in 2023 reported delaying or not getting some form of healthcare due to cost.^b Findings of a recent  survey by the PAN Foundation, a leading healthcare advocacy organization, suggest that healthcare affordability has reached a critical tipping point as one third of the nation faces monthly premium costs exceeding $1,000.^c The survey found that among 2,084 adult American respondents, 86% believe healthcare affordability and costs should be top of mind for policymakers and elected officials.  

“We have Band-Aid solutions,” said Amy Niles, chief mission officer at the PAN Foundation. “But at some point, we need to sit back and ask, ‘What kind of healthcare system do Americans want?’”  

Now cancer-free, McDonald addresses that question by suggesting that hospitals can better leverage opportunities to help patients navigate the financial aspects of their care.  

“Everyone talks about wanting to put patients first, but if you truly want that, then why aren’t you letting patients focus solely on their health?” he said. “My feeling is that I shouldn’t need to be the expert and find all these financial resources.” 

Complying with evolving state laws 

At Denver Health, patient financial navigation has been a top priority, most recently as the health system began complying with a new state law that took effect in July 2025. Under Colorado’s Hospital Discounted Care law, all hospitals must proactively screen patients for public coverage and discounted-care eligibility using a uniform application, notify patients of their rights, limit charges for patients with incomes at or below 250% of the federal poverty guidelines and offer income-based payment plans capped at a percentage of household income with remaining balances forgiven after 36 months.^d

One of the biggest challenges is simply collecting patient information, said April Audain, CFO at Denver Health.  

“There’s a lot of data you have to get from someone to see if they qualify for certain programs,” she said. “I think part of what we’re seeing in some instances is really based on current administration and being fearful of giving this information to folks.”^e

With Medicaid eligibility continuing to evolve and advanced premium tax credits remaining in limbo, Audain said hospitals must be nimble.  

“We know it’s going to be a challenge for everyone, not just us,” she said. “We have just started discussions with our team on how we can handle enrollment changes and what kinds of resources we might need. It’s going to be a heavy lift for all organizations.” 

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Digging into the root causes of rising healthcare costs 

Hospital-led patient financial navigation is only part of the solution to healthcare affordability, said Jenni Alvey, senior vice president and CFO at Indiana University (IU) Health in Bloomington, Indiana. 

“We are in some of the highest inflationary times in healthcare history,” she said. “Hospitals must figure out how to fund their own inflation  so they don’t continue to pass all of it on to consumers and employers.” 

In 2020, IU Health launched a five-year plan focused on making care more affordable by lowering average commercial prices, even as labor, drug and supply costs increased by 4.1%, 3.0% and 2.3%, respectively, each year.  

For Alvey, who grew up on a farm in southern Indiana, this mission is deeply personal, given the challenges facing rural healthcare.  

“Providing high-quality, affordable care has always been really inspirational to me,” she said. 

To reduce costs, the health system worked collaboratively with two major commercial payers to adopt a sensible pricing strategy that resulted in increased prices for complex services such as surgeries while making straightforward services more affordable.  

“We spent a lot of time with them building this plan together,” said Alvey. “It was a combined effort.” 

The results? By the end of 2025, prices for radiology had dropped 26% on average. Lab costs decreased by 62%, outpatient pharmacy by 33% and ambulance services by 24%. For example, the cost of a CT scan of the abdomen decreased from about $1,500 to $750. The cost of a breast ultrasound decreased from about $5,800 to $3,600. 

IU Health absorbs these costs partially through volume growth and partially through efficiency gains/reduced spend, Alvey said. Steps the health system made include:  

• Centralizing microbiology lab tests to reduce overall cost per test  
• Centralizing warehouse/distribution services and scheduling/registration services 
• Consolidating property management 
• Establishing a program to maximize equipment usage systemwide 
• Reducing administrative office space 
• Identifying efficiency benchmarks to be monitored 

“We really changed the way we delivered care,” says Alvey. “We took a hard look at our services and made sure we were productive, efficient and using all of our assets.” 

Redesigning care delivery to reduce costs for patients 

Redesigning care delivery to make healthcare more affordable is also a key strategy for Corewell Health, headquartered in Grand Rapids and Southfield, Michigan.  

“We have to think about making care affordable one patient at a time because everybody’s health journey is different,” said Matthew Cox, CFO. “What we’re really trying to do is arm patients with the right information.” 

Over the past decade, Corewell Health centralized and expanded its around-the-clock nurse triage system beyond primary care to include women’s health, neurology, ENT and urology. One of the goals? Prevent patients from going to the ED where they might incur hundreds or thousands of dollars of debt when they could be seen safely in lower-level, less expensive care settings or even manage their own symptoms at home.  

Empathic patient education is critical, said Lori Stoepker, Corewell Health’s manager of primary care and after-hours nurse triage, who oversees a team of 75 nurses, all funded by shared savings the health system generates through its ACO.  

“Not every symptom requires a visit, and we really want to make sure we match access to patient acuity,” Stoepker said.  

In addition to Stoepker’s team, a separate specialty team of about 40 nurses handles  
specialty-related calls, and a centralized medication refill team of 20 nurses for medication requests after hours and on the weekends.  

“Not having to go to the ED for a medication refill saves patients hundreds of dollars,” Cox said. 

As part of its efforts to make care more affordable, Corewell Health also closely monitors its ED data, including its volume of patients and reasons why triage nurses refer patients to the ED.  

“Every month, we make changes,” Stoepker said. “We add more alternative care sites, whether it’s a walk-in clinic or urgent care to lower the cost of care and provide quicker care for our patients.” 

Developing external partnerships for financial literacy 

At NYC Health + Hospitals, moving the needle on healthcare affordability involves an external partnership and a holistic approach to patient financial health. More specifically, the NYC Department of Consumer and Worker Protection runs city-funded financial empowerment centers embedded within eight of the health system’s hospital locations. These centers, designed to improve general financial literacy, provide free one-on-one financial counseling as well as free tax preparation. 

“We think about it as [a] medical-financial partnership,” said Samantha Kumar, MPH, senior director, social medicine and population health. “What’s great about leveraging this partnership is that they already have their own partnerships in the financial sector. We can tap them for their expertise. The reason we provide free tax prep services is because tax credits can often be the largest influx of income each year for our low-income patients. Helping patients claim their tax credits gives them options to pay for everyday necessities, including medical costs.” 

Kumar noted that even after only a few months of offering the service, the health system has already seen a 10% or more reduction in personal debt for some patients.  

“This includes a broad range of debt — credit card, student loan and medical debt,” Kumar said. 

This partnership comes against the backdrop of former New York City Mayor Eric Adams’ announcement in January 2024 that he would invest $18 million over three years to relieve more than $2 billion in medical debt for hundreds of thousands of working-class New Yorkers. To accomplish this goal, the city is currently partnering with Undue Medical Debt, a national New York City-based nonprofit organization that uses donations to buy medical debt in large, bundled portfolios at a steep discount.  

NYC Health + Hospitals also provides a sliding fee scale program to patients who meet certain criteria. The program covers a broad range of services, including primary care, women’s health, ophthalmology, nutrition, mental health, specialty care, substance abuse disorders treatment, medications, eyeglasses and durable medical equipment.  

Looking ahead 

“There are always opportunities for all of us to look at our infrastructure, keep costs low and be as transparent as possible,” Niles said. “When it comes to affordability, I hope the hospital industry is as vocal as possible and has a seat at the table when solutions are presented.” 

Audain agrees. “There is an excitement about what we can do differently. How do we partner with each other to ensure that our community stays healthy? I think it’s going to be a very interesting time for healthcare as a whole over the next year.”  

Footnotes

a. . See Wooddell, B., “Meet Tim McDonald: Colorectal cancer survivor turned advocate,” Bloom TV, March 4, 2024.
b. Rakshit, S., et al., “How does cost affect access to healthcare?” Peterson – KFF Health System Tracker, April 7, 2025.
c. PAN Foundation, Healthcare costs and policy poll end-of-year 2025, October 2025.
d. Colorado Department of Health Care Policy & Financing, “Colorado hospital discounted care,” 2026.
e. In November, HHS and CMS announced they will share certain information with the U.S. Department of Homeland Security (DHS) and its component agency, the U.S. Immigration and Customs Enforcement, consistent with federal laws requiring the provision of information to DHS (see CMS, “Notice of Medicaid information sharing between the Centers for Medicare & Medicaid Services and the Department of Homeland Security,” Federal Register, Nov. 25, 2025).

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