Stories that
move the needle

Every year, an estimated 2.3 million Americans avoid emergency care because they're afraid of the bill. Some of them die from conditions that would have been treatable. This guide is for them.

The Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, requires that any hospital accepting Medicare — which is nearly every hospital in the United States — must screen and stabilize any patient who presents to their emergency department, regardless of ability to pay, insurance status, or immigration status. You cannot be turned away. You cannot be asked for your insurance card before you are stabilized.

The No Surprises Act of 2022 added additional protections: out-of-network providers in an in-network facility cannot bill you more than your in-network cost-sharing. If you receive a surprise bill, you have 120 days to initiate a dispute.

What this means practically: show up. Get seen. The financial conversation happens later — and it is a conversation you have significant leverage in, especially if you are uninsured. Hospitals are legally required to have financial assistance programs. Non-profit hospitals (which are most hospitals) are required by law to provide charity care to patients below certain income thresholds — typically 200–400% of the federal poverty line.

Ask for the hospital's financial counselor. Ask specifically about "charity care," "financial assistance," or "Hill-Burton obligations." Don't leave without knowing what programs you qualify for.

Insulin has been around for over a century. It was discovered in 1921 at the University of Toronto. The patent was sold to the university for $1. The discoverers explicitly did not want it to become a monopoly.

In 2023, the list price of a single vial of Humalog (insulin lispro) was $274.70. The estimated manufacturing cost per vial: roughly $2–6. Three people in the United States died rationing insulin in 2023 that we know of. The true number is higher.

The Inflation Reduction Act of 2022 capped Medicare insulin costs at $35/month. President Biden's executive action extended $35 caps to Medicaid in many states. Manufacturers Eli Lilly, Novo Nordisk, and Sanofi — who together control 90% of the U.S. market — announced voluntary $35 caps for uninsured patients in 2023.

But voluntary caps have gaps. They apply to branded products, not all formulations. They require paperwork. They expire. And they don't help the 16 million Americans who are neither insured nor Medicaid-eligible but also can't navigate a manufacturer PAP program at 2am when they're out of insulin.

The solution AXVO has implemented: our Programs page surfaces the 340B drug pricing program, manufacturer PAP programs, state-level insulin programs, and community health centers that dispense insulin on a sliding scale. For most uninsured patients, insulin can be obtained for $8–$35/month through stacked programs. The knowledge gap is more lethal than the access gap.

The American Rescue Plan of 2021 dramatically enhanced Affordable Care Act subsidies, making coverage free or near-free for millions of Americans. The Inflation Reduction Act of 2022 extended those enhancements through December 31, 2025.

After that date, premiums could rise by $300–$600/month for many enrollees. CBO estimates 3 million people could lose coverage. The disproportionate impact falls on people earning 200–400% of the federal poverty line — working people who earn too much for Medicaid but can't afford unsubsidized premiums.

What's important to understand: even if you lose marketplace coverage, there are alternatives. Every person in the United States is within 30 miles of at least one Federally Qualified Health Center that is required by federal law to provide care on a sliding scale regardless of insurance status.

AXVO is monitoring this situation. If you're currently enrolled in an ACA marketplace plan and concerned about December 2025, use our Programs eligibility checker now to understand your full range of options — including Medicaid, CHIP, and 340B pharmacy access — before the deadline.