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: June 25, 2025 at 4:04am
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
Eleven of fourteen Missouri hospitals investigated by KHN from November 2021 to December 2022 have policies allow ing them to report unpaid medical bills to credit-rating agencies . Ten hospitals may also sue patients or take other legal actions to collect unpaid medical bills. Two hospitals’ policies even allow ed them to deny nonemergency care to patients who owe the hospital money .2
Medical Debt and Consumer Protections
Missouri’s consumer protection policies for medical debt are rated as “WEAK.” For example, Missouri law:
Does not prohibit the selling of medical debt. Does not prohibit hospitals from seizing a patient’s bank account to collect an unpaid medical bill. Does not require hospitals to screen patients for insurance eligibility or eligibility for discounts and other programs. Does not require hospitals to offer a reasonable payment plan before sending a bill to collections.3 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 higher than the national average of 8.6% for the same period.4
Medical Debt in Collections
Based on credit bureau data from August 2023, Urban Institute found that 7% of Missourians have medical debt in collections , more than the n ational average of 5%. In Missouri’s communities of color, roughly 12% of people have medical debt in collections, exceeding the 6% national average.5
Price Transparency
A survey of 2,000 hospitals nationwide from September 2023 to January 2024 found that only 6 out of 43 Missouri hospitals – just 14 % – had complied with federal regulations requiring all hospitals to post their prices online and make them easily accessible and searchable.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 40 th in the country for hospital safety, with less than 17% of its hospitals earning an ‘A’ grade for patient 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/
National Public Radio, “Investigation: Many U.S. hospitals sue patients for debts or threaten their credit,” December 2022, https://www.npr.org/sections/health-shots/2022/12/21/1144491711/investigation-many-u-s-hospitals-sue-patients-for-debts-or-threaten-their-credit
Innovation for Justice, University of Arizona and the University of Utah, “Medical Debt Policy Scorecard,” October 2021, https://www.medicaldebtpolicyscorecard.org/state/MO
Peterson-KFF Health System Tracker, “Access & Affordability: The Burden of Medical Debt in the United States,” February 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
Urban Institute, “Debt in America: An Interactive Map,” September 2024, https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=29
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, Spring 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.
