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Updated: October 26, 2025 @ 12:58 pm
Grady hospital officials say they anticipate a $100 million budget impact next year if the enhanced Affordable Care Act premium subsidies expire as proposed. That’s on top of federal Medicaid funding cuts under the Trump administration’s big tax and spending law.
Grady hospital officials say they anticipate a $100 million budget impact next year if the enhanced Affordable Care Act premium subsidies expire as proposed. That’s on top of federal Medicaid funding cuts under the Trump administration’s big tax and spending law.
Grady Memorial Hospital officials are preparing for financial losses as a result of the one-two punch of federal Medicaid funding cuts under H.R. 1, also known as the One Big Beautiful Bill Act, and the proposed expiration of enhanced Affordable Care Act marketplace tax credits later this year.
“The ACA plans and the additional funding that was in place for people to be able to afford their plans, if that truly goes away, that is a $100 million impact to Grady next year,” said Grady CEO John Haupert. “This is on top of everything else we’ve experienced.”
Grady is Atlanta’s only Level I Trauma Center after the 2022 closure of Wellstar’s Atlanta Medical Center.
Without a deal in Congress, expiration of the pandemic-era enhanced ACA tax credits means people with marketplace coverage would see their monthly premiums spike by more than double next year on average, according to KFF.
And nearly 5 million Americans are expected to lose their health insurance next year, with the Congressional Budget Office forecasting changes to the ACA and cuts to federal Medicaid funding would leave 14 million more Americans uninsured by 2034.
Grady Chief Operating Officer Anthony Saul said his team is working to avoid having to make future cuts to patient services.
“For us, we are working on mitigation plans and operation improvement plans, but the challenge will be that Grady’s patient population requires so many wraparound services that already go unfunded,” he said. “And so we will be stretched to continue doing all the great work that we’ve done for those populations that are so vulnerable.”
Saul said it would be premature to specify which services could see cutbacks in coming years, stressing his hopes that Grady’s efforts to avoid service cuts would bear fruit.
The health system will be forced to continue doing “more with less,” he said.
“But at some point, the math doesn’t math, and it just doesn’t work anymore,” Saul said. “We are comfortable with our plans right now to mitigate this level of cuts. But any more cuts and you really start cutting into the services that we provide.”
Nationwide, a report from George Washington University and The Commonwealth Fund found 339,100 jobs would be lost next year if the enhanced premium ACA tax credits expire.
Georgia would lose 33,600 jobs in 2026 — the third-highest expected loss in the United States after Florida and Texas, according to the same analysis.
Georgia’s health care system already faces provider shortages.
“By 2032, we’ll need to fill almost 240,000 additional health care jobs,” said Georgia Hospital Association CEO Caylee Noggle.
She led a “fireside chat” discussion Tuesday with Georgia Gov. Brian Kemp at the state’s third annual Governor’s Workforce Summit at the Georgia World Congress Center.
Kemp told the crowd of industry officials and state lawmakers that he remains committed to growing Georgia’s health care workforce, expanding state workforce training and career initiatives.
“Trying to make sure that we are giving people opportunity no matter their zip code,” he said. “But when we do that and you have these companies going there, you gotta have the workforce for their needs, but then also you’ve got to serve the health care of that community, and that’s something that we have to continue to work on — good problems to have in rural Georgia.”
Kemp didn’t address federal funding cuts or potential job losses. He focused on his administration’s statewide efforts to address rural health care workforce gaps, including allocating increased funding for medical training, and a recently announced agreement between the University System of Georgia and the Technical College System of Georgia to allow some health care students to more easily transfer between schools.
“And it’s just going to help us train people quicker, and whether it’s somebody that’s new to the workforce or somebody that is transitioning, you know, from one position to a better one, or somebody that’s laid off that needs to figure out a new career and they need to do it quick, it’s gonna be helpful in us doing that. And it’s all about meeting the needs of the job creators in our state,” Kemp said.
Open enrollment for ACA marketplace health plans begins Nov. 1.
Window shopping for plans is available at Georgia Access.
Atlanta Mayor Andre Dickens said he’s pushing for Fulton County, state and federal officials to extend the marketplace tax credits.
He spoke this week with health and philanthropic advocates at an event hosted by the ARCHI group.
“Because when they make cuts in the ACA, you have people in urban, suburban, and rural America hurting. And those are the voices of their voters. So I want the federal government to think about that,” he said.
Decaturish media partner WABE provided this story.
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