While nonprofit hospitals are organized as charities to deliver affordable health care to those in their communities who need it most, many of America’s nonprofits are making big money. Nonprofit hospitals around the country are paying executives exorbitant salaries and adopting policies that put profits over patients, like pursuing predatory collection practices, closing hospitals that are critical to underserved areas but aren’t performing financially, and failing to provide free or reduced-cost care for qualifying low-income patients. Too often, these policies are combined with poor health outcomes for patients.
Last updated: January 12, 2026 at 9:36pm
Charity Care Spending
Hawaii had a “fair share deficit” of $197 million dollars for the fiscal year ending in 2021, according to the Lown Institute Hospitals Index. In other words, Hawaii’s nonprofit hospitals pocketed a whopping $197 million more in tax breaks than they spent on community benefits and charity care for low-income patients. In fact, the Lown Institute found that 90% of Hawaii’s nonprofit hospitals ran a fair share deficit in the 2021 fiscal year.1
Hospital Collection Policies
Most hospitals (59%) allow at least one extraordinary collection action, like wage garnishments, selling debt to a third party or denying non-emergency care. Of the 11 Hawaii hospitals investigated by the Lown Institute from June 2024 to April 2025, seven had written policies allowing them to take legal actions against patients for unpaid medical debt. Three Hawaii hospitals’ policies even allowed them to deny nonemergency care to patients who owe the hospital money.2
Medical Debt and Consumer Protections
Medical debt adversely affects many Americans. Given vague and rarely enforced federal medical debt protections, states are on the frontlines of patient medical debt protections. Unfortunately the District of Columbia:
Does not
Does not
Does not
Provides only partial protection against health care providers’ placing liens on a person’s home or foreclosing on their home to collect a medical debt.
Provides only limited protection against the use of wage garnishments to collect a medical debt.3
Price Transparency
A survey of 2,000 hospitals nationwide from July to November 2024 found that none of the 8 Hawaii hospitals reviewed – not a single hospital – had complied with federal regulations requiring all hospitals to post their prices online and make them easily accessible and searchable.4
Hospital Overcharging
On average, from 2020 to 2022, hospitals in Hawaii charged patients with private insurance an average of 245% of what they charged Medicare patients for the same services.5
Hospital Safety
Hawaii ranks 41st in the country for hospital safety, with barely 16.7% of its hospitals earning an ‘A’ grade for safety.6
Grade: #HospitalFail
Lown Institute, “Lown Institute Hospitals Index: 2024 Results Fair Share Spending,” April 2024, https://lownhospitalsindex.org/hospital-fair-share-spending-2024/
Lown Institute, “Hospital Financial Assistance and Debt Collection Policies,”June 2025, https://lownhospitalsindex.org/report-hospital-financial-assistance-and-debt-collection-policies/
Commonwealth Fund, “State Protections Against Medical Debt: A Look at Policies Across the U.S. in 2025,”July 2025, https://www.commonwealthfund.org/publications/fund-reports/2025/jul/state-protections-against-medical-debt-look-policies-across-us
PatientRightsAdvocate.org, “Seventh Semi-Annual Hospital Price Transparency Compliance Report,” November 2024, https://www.patientrightsadvocate.org/seventh-semi-annual-hospital-price-transparency-report-november-2024 , pg. 28
Rand Corporation, “Prices Paid to Hospitals by Private Health Plans: Findings from Round 5.1 of an Employer-Led Transparency Initiative,” December 2024, https://www.rand.org/pubs/research_reports/RRA1144-2-v2.html
Leapfrog Hospital Safety Grade, State Rankings, November 2025, https://www.hospitalsafetygrade.org/your-hospitals-safety-grade/state-rankings
Consumers for Quality Care (CQC) is a coalition of advocates and former policymakers working to provide a voice for patients in the health care debate as they demand better care. CQC is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Edward Kennedy and Harry Reid; Jason Resendez, community advocate and health care strategist; and Mary L. Smith, former CEO of the Indian Health Service.
