Commercially insured scheduled admissions are the largest contributor to inpatient margins for the average US hospital. During the US recession (2009-2011), volumes in this segment declined. There were two primary drivers of this decline. First, commercial insurance coverage decreased, stemming from unemployment and underemployment. This is expected to reverse and rebound as the economy recovers and as healthcare reform is implemented. Second, even among those who retained coverage, utilization of inpatient services decreased as patients delayed or forewent elective and preventative care. This was influenced by a range of economic factors, including reduced household incomes, higher co-pays, and a reduced ability to leave work for medical care, as well as factor unrelated to the recession, such as a shift to outpatient management of disease. It is unclear whether this second driver will diminish fully as the economy recovers. A slow recovery - or one that fails to see volumes to return to pre-recession levels - suggests that hospitals may need to refocus their strategies on service lines and segments that have historically been less attractive.