Millions Lack Health Coverage. Many Hospitals Offer Less Help Than They Should. This Has Been True for Decades.

As ranks of uninsured grow, charity care can be hard to come by at many hospitals

What Happened

NPR reports that the number of uninsured Americans is growing, and that many hospitals — including nonprofit hospitals that receive significant tax exemptions in exchange for providing charity care — are not providing adequate free or reduced-cost care to low-income patients. Uninsured patients are often billed full rates and denied the financial assistance that hospitals are, in some cases, legally or ethically obligated to provide.

Historical Context

The U.S. uninsured rate hit a historic low of 7.7% in 2023 (roughly 25 million people) following ACA expansions, but has ticked upward since Medicaid unwinding began in 2023, with an estimated 9–10 million losing Medicaid coverage. Nonprofit hospitals receive approximately $28 billion per year in federal tax exemptions, yet a 2023 Lown Institute study found that 77% of nonprofit hospitals spent less on charity care than the value of their tax breaks. This tension is not new: Congress has been debating charity care obligations since the Hill-Burton Act of 1946, which required hospitals receiving federal funds to provide free care — a requirement largely phased out by 1997.

What's In Your Control

Whether you know your rights: uninsured patients can request an itemized bill, ask for the hospital's financial assistance policy (federally required to be public), and negotiate bills down — often dramatically. Whether you help someone you know navigate this: many people don't realize charity care exists and never apply. Whether you contact your Congressional representative if this issue matters to you.

Does This Require Action?

If you or someone you know is facing a large hospital bill without insurance: action required — ask for the financial assistance application before paying anything. For everyone else: awareness. This is a systemic issue worth understanding, but not one that requires daily anxiety.