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 correlate with poor health care outcomes for patients.
Last updated: February 23, 2026 at 3:20pm
Charity Care Spending
Texas hospitals had a “fair share deficit” of $ 643 million from 2020 to 2022 , according to t he Lown Institute . In other words, Texas ’s nonprofit hospitals pocketed a whopping $ 643 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 4 2 % of Texas’s nonprofit hospitals ran a fair share deficit for that period .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 157 Texas hospitals investigated by the Lown Institute from June 2024 to April 2025, 19% had written policies allowing them to take legal actions against patients for unpaid medical debt. 19 Texas 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 Texas:
Does not
Does not
Does not 3
Price Transparency
A survey of 2,000 hospitals nationwide from July to November 2024 found that just 9 4 out of 135 Texas hospitals – less than half – 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 Texas
According to a Peterson-KFF analysis of data from 2019 to 2021, o n average, 10.7% of adults (about 2,300,000 people) in Texas report having medical debt in a given year . This estimate is higher than the national annual average of 8.6 %.5
Medical Debt in Collections
Based on credit data from August 2025, Urban Institute found that 8% of Texans have medical debt in collections , more than the national average of 3%. In Texas’ communities of color, roughly 8% of people have medical debt in collections, exceeding the 4% national average.6
Hospital Overcharging
On average, from 2020 to 2022 , Texas hospitals charged patients with private insurance an average of 250% of what they charged Medicare patients for the same services.7
Hospital Price Variation
A 2025 review of Texas hospital prices showed huge price variations for the same medical procedures. The price charged for arthroscopic knee surgery varied by as much as 22.8x from one hospital to the next.8
Additionally, some hospitals charged patients wildly different prices for the same procedure. Christus Spohn Hospital Corpus Christi Shoreline, for example, charged some insurance plans as much as $10,210 for arthroscopic knee surgery and as little as $536 for the same procedure.9
Grade: #HospitalFail
Lown Institute, “Making Hospital Tax Breaks Work for Communities: An Analysis of 20 states,” April 2025, https://lownhospitalsindex.org/report-making-hospital-tax-breaks-work-for-communities/
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,” February 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
Urban Institute, “Debt in America: An Interactive Map,” November 2025, https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=48
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
PatientRightsAdvocate.org, “The Interim Semi-Annual Hospital Price Transparency Report,” September 2025, https://www.patientrightsadvocate.org/interim-semi-annual-hospital-price-transparency-report , Appendix D
PatientRightsAdvocate.org, “The Interim Semi-Annual Hospital Price Transparency Report,” September 2025, https://www.patientrightsadvocate.org/interim-semi-annual-hospital-price-transparency-report , Appendix B
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.
