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 largest 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 serve 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 care outcomes for patients.
Last updated: March 16, 2026 at 10:37am
Charity Care Spending
Kentucky had a “fair share deficit” of nearly $433 million dollars for the fiscal year ending in 2021 , according to the Lown Institute Hospitals Index. In other words, Kentucky’s nonprofit hospitals pocketed a whopping $433 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 nearly 88% of Kentucky’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 70 Kentucky hospitals investigated by the Lown Institute from June 2024 to April 2025, 57% had written policies allowing them to take legal actions against patients for unpaid medical debt. Twenty-two Kentucky 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 Kentucky:
Does not
Does not
Does not
Does not 3
Price Transparency
A survey of 2,000 hospitals nationwide from July to November 2024 found that only 4 of 31 Kentucky hospitals reviewed – or just 13 % – had complied with federal regulations requiring all hospitals to post their prices online and make them easily accessible and searchable.4
The Burden of Medical Debt in Kentucky
In Kentucky , an average of 12 % of adults in a given year (or 410,000 people) reported having medical debt, according to a Peterson-KFF analysis of data from 2019 to 2 021. That’s more than the national average of 8.6 %.5
Medical Debt in Collections
Based on credit bureau data from August 2025 , Urban Institute found that 5 % of Kentuckians have medical debt in collections, more than the national average of 3 %. In Kentucky’s communities of color, 9 % of people have medical debt in collections, far exceeding the 4H % national average.6
Hospital Overcharging
On average, from 2020 to 2022, hospitals in Kentucky charged patients with private insurance an average of 254 % of what they charged Medicare patients for the same services.7
Grade: #HospitalFail
Lown Institute, “Making Hospital Tax Breaks Work For Communities: An analysis of 20 states,” April 2025, 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
Peterson-KFF Health System Tracker, “Access & Affordability: The Burden of Medical Debt in the United States,” September 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/#Share%20of%20adults%20who%20have%20medical%20debt,%20by%20state,%202019-2021
Urban Institute, “Debt in America: An Interactive Map,” November 2025, https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=20
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
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.
