CommonSpirit and nonprofit hospitals are turning medical debt into a public burden

The Florida Courier’s account of nonprofit hospitals pursuing struggling patients over small bills while paying executives millions puts the medical-debt crisis where it belongs: inside institutional decision-making.¹

CommonSpirit’s finances make the contrast plain: lawmakers questioned its leadership about $718 million in publicly traded securities and $134 million in investment gains, alongside compensation packages of $21 million for a former chief executive and $14 million for the current one.¹ The question is not whether a hospital may keep reserves or invest in care. It is whether an institution receiving tax advantages can treat collections as routine while treating assistance as a cost to contain. Tax-exempt hospitals already face federal obligations to make reasonable efforts to determine eligibility for financial assistance before extraordinary collections.¹

This is not a problem limited to people without insurance: one-third of people with private health insurance hold medical debt.² One-third of privately insured Americans hold medical debt.² KFF estimated that Americans owed at least $220 billion in medical debt in 2024, including 14 million people with more than $1,000 owed and 3 million with more than $10,000.³

These measures should be interpreted carefully rather than treated as interchangeable. But together they show why medical debt cannot be reduced to a few careless patients or unfortunate emergencies. A deductible may force a household to borrow, empty its savings or fall behind on rent.¹

The burden is also racialized. In 2021, 13 percent of Black adults owed more than $250 in medical debt, compared with 8 percent of white adults; between 2022 and 2025, median Black family wealth fell from $49,100 to $36,800 while white family wealth rose from $311,900 to $332,100.¹ A bill therefore extracts more than cash: it can consume the assets that make recovery possible.

A 2022 investigation of 528 hospitals found policies allowing lawsuits and other aggressive collection practices, while financial assistance was often difficult to find or secure.¹ Posting a charity-care form is not meaningful access if a sick patient cannot locate, understand or complete it.

Congress should impose clear minimum standards for free and discounted care, enforce eligibility protections before collections, and require wealthy systems to justify how their public privileges serve patients. Credit-reporting reforms would not, by themselves, make medical bills affordable. The real test is whether hospitals stop transferring their financial discipline onto families least able to absorb it.