Hospitals, physicians and other health care providers stand to lose tens of billions of dollars in revenue and face billions of dollars in uncompensated care with the expiration of enhanced federal subsidies for health coverage. 

Washington state would be among those states least impacted, according to a recent report from the Urban Institute. However, the state’s health care providers would still see a projected $160 million loss of revenue and $102 million increase in uncompensated care. 

Premium tax credits available to those buying health coverage via the marketplaces created through the Affordable Care Act will sunset on Dec. 31. Efforts in Congress to extend or permanently enshrine the tax credits have not moved forward. 

States that have not expanded Medicaid coverage stand to face the greatest loss of coverage and revenue, according to the report. 

Regardless, failure to extend the premium tax credits will create a feedback loop of lower health care spending, diminished services and that would further strain a health care system that is already struggling. 

“Because lower spending on health care services means lower revenue for health care providers and fewer services rendered, the resulting decline in revenue could have adverse consequences, particularly for already financially at-risk hospitals and the communities they serve,” according to the report. “This loss of health insurance coverage could have significant negative consequences for individuals, as health care use declines and unmet health care needs increase when people become uninsured.”