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 from questionable practices. Nonprofit hospitals around the country are paying executives exorbitant salaries and adopting policies that put profits over patients, like pursuing predatory collection practices and failing to provide free care for qualifying low-income patients. Too often, these policies are combined with poor health care outcomes for patients.
Last updated: February 23, 2026 at 3:04pm
Charity Care Spending
The Lown Institute Hospitals Index found that, based on tax filings from the fiscal year ending in 2021, Missouri hospitals had a collective “fair share deficit” of $ 255 m illion dollars. In other words, Missouri ’s nonprofit hospitals pocketed tax breaks that were a whopping $ 255 m illion more than what they spent on community benefits and charity care for low-income patients. In Missouri, almost half of all nonprofit hospitals – 45 percent – had a fair share deficit.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 53 Missouri hospitals investigated by the Lown Institute from June 2024 to April 2025, 45% had written policies allowing them to take legal actions against patients for unpaid medical debt. One Missouri hospital’s policy even allowed it 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 Missouri:
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 just 6 of the 43 Missouri hospitals reviewed – a mere 14% – 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 Missouri
In Missouri, an average of 10.6% of adults in a given year (or 500,000 people) reported having medical debt, according to a Peterson-KFF analysis of data from 2019 to 2021. That’s more than the national average of 8.6.5
Medical Debt in Collections
Based on credit data from August 2025, Urban Institute found that 5% of Missourians have medical debt in collections , more than the national average of 3%. In Missouri’s communities of color, roughly 12% of people have medical debt in collections, exceeding the 4% national average.6
Hospital Overcharging
On average, from 2020 to 2022 , Missouri hospitals charged privately insured patients more than 2 46 % of what they charged Medicare patients for the same services.7
Hospital Safety
Missouri ranks 40th in the country for hospital safety, with barely 17% of its hospitals earning an ‘A’ grade for safety.8
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
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=29
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, Fall 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.
