First, they lost their health insurance. Then they got unpaid sick leave.
Now, they are facing much higher hospital bills — or losing their health insurance altogether.
Across the country, hospitals are being forced to tighten their belts, despite a growing patient population that is sicker and spending more on health care.
The Affordable Care Act extended eligibility for Medicaid, the federal-state health program for the poor, to adults up to age 49 and younger than 26.
But the law also required hospitals to pay back the federal government for “unpaid uncompensated care,” a sum that grew significantly after the law passed. The cost is subtracted from a hospital’s hospital bill, which can lead to price increases. In many states, that practice is also intended to increase competition.
In recent months, hospitals across the country have been warning patients about the potential consequences.
In Massachusetts, two networks of hospitals — the Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary — laid off 20 of 40 licensed clinical social workers as they cut back on elective surgery. They hope to cut costs by lowering elective procedures, which are usually less expensive.
“Our costs are determined by the patients and all of the services we provide, not the coverage policies,” a spokeswoman for the network said.
In Connecticut, officials in St. Vincent’s Hospital have said they may lose access to Medicare in the future, since the state stopped covering hospitals in 2011.
Hospitals around the country say they have been quietly warning patients and their doctors, though they have not yet spoken out publicly. Most are reporting lower turnover among staff.
“Everyone is working harder, and everyone is happier, but we are making less money because of these changes,” Dr. Bruce Friedman, a doctor at the University of Washington, said in an interview.
Dr. Friedman, the chairman of the American College of Cardiology, had to lay off staff and cut services because of an increase in the hospitals’ unpaid uncompensated care costs, as they sought to avoid unpaid bills from older patients who cannot pay their medical bills. The group was also faced with new pressure: the number of people seeking specialty care is rising.
Doctors say patient fears about increasing costs have led them to defer elective surgeries, at least for now.
“Folks with Medicare were very scared, and many of them — people who thought they were in the clear — got turned down,” Dr. Friedman said. “We were also trying to work with those people to get the right services.”