While most health systems expect the most significant policy effects of HR 1 to hit in 2027 and beyond, several large systems are already reporting early signs of payer mix deterioration tied to the legislation.
Orlando Health said in its Q1 2026 financial report that it has seen early indications of payer mix shifts “due to affordability, eligibility redetermination, plan costs and ACA marketplace enrollment trends.” Altamonte Springs, Fla.-based AdventHealth, which operates 55 hospitals in nine states, said it is also observing early evidence of shifts — including movement from commercial coverage to government-sponsored programs and growing uninsured populations — in some of its markets.
The numbers are already moving at some systems. Charlotte, N.C.-based Advocate Health’s commercial revenue share dropped from 51% to 45% year over year in Q1 2026, while its Medicaid share rose from 17% to 22%. Chicago-based CommonSpirit Health cited “deterioration in payer mix” as one of the primary drivers behind its ongoing operating losses.
For health systems, even modest shifts in payer mix can have an outsized effect on margins, making the changes reported in first-quarter earnings an early indicator of HR 1’s broader financial effect.
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