Hospitals have a lot of leeway to decide who is eligible for financial assistance. In some cases, hospitals don't allow any elective care to be eligible. What impact could that have on health or medical debt?
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The data to support these criticisms has been cataloged and quantified by the Lown Institute, a nonpartisan think tank interested in “bold ideas for a just and caring system for health.” It’s abundantly clear that “nonprofit” is now a misnomer when referring to hospitals. The fair share deficit — the disparity between what a hospital provides its community and what it receives from the American taxpayer — reached an all-time high of $25.7 billion in 2024. Yet fully 80% of “no-profit” hospitals claimed to be “in the red.
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The Lown Institute has released its highly anticipated index of America's Most Socially Responsible Hospitals. This year's honor roll comes at a critical time, as hospitals work to maintain equitable care amid potential Medicaid cuts, rising costs and ongoing workforce challenges. Duke Regional Hospital topped this year's acute care ranking, marking its fifth year on the list.
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Lown, a nonpartisan healthcare think tank, annually evaluates hospitals nationwide on more than 50 metrics pertaining to equity, value and health outcomes. Out of more than 2,700 acute care hospitals nationwide, Lown recognized 125 “Honor Roll” hospitals for achieving the highest scores in its latest 2025-2026 rankings.
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“We're in the business of meeting people where they are,” Jason Carter [president and chief operating officer of Duke Regional] said. “So for us, access is the best indicator for downstream care. How can we care for our community, not in episodes of care, but creating systems of care? And that will only happen when we create trust with our community and do things, and engage in ways that people know it is safe to come seek their care with us.”
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“These hospitals show that no matter how tough the environment gets, putting patients and communities first is always possible,” Vikas Saini, M.D., president of the Lown Institute. “Those returning to the list prove that equitable, high-value care doesn’t have to be rare, it’s a standard hospitals can uphold year after year.”
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Register now for the webinar "America's Most Socially Responsible Hospitals" on June 25, 2025.
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"The enterprise of medicine has both scientific and moral dimensions, and they're inextricably balanced"
Dr Vikas Saini is a Cardiologist and President of the Lown Institute, where he leads a non-partisan think tank advocating bold ideas for a just and caring system for health. With a unique background combining philosophy and medicine, Dr. Saini has spent decades examining the intersection of ethics, evidence, and economics in healthcare. His work on the Social Responsibility Index challenges traditional hospital rankings by measuring what truly matters: equity, value, and patient outcomes rather than reputation and revenue.
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"When hospitals fail to make access to assistance easy and predictable, it drives people away from care and erodes trust in our entire system," Saini explained. "Right now, the burden is on patients to navigate a broken system. That has to change."
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“This isn’t a case of red states versus blue states, or rural areas versus cities,” Vikas Saini, MD, president of the Lown Institute, said in a June 2 news release from the organization. “We’re seeing massive disparities in charity care policies between hospitals that are practically around the corner from each other. Unfortunately, low- and middle-income patients are the ones who deal with the consequences.”
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Analysis of 2,500 charity care policies finds patients with identical income and medical needs could receive free care at one hospital, yet face collections or lawsuits at another.
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Medical debt impacts tens of millions of Americans, contributing to financial harm and worse health. This report provides an overview of research on prevalence, impact, and drivers of medical debt, finishing with policy recommendations to address both the downstream problem of medical debt and the systemic issues behind the problem.
Suggested citation: Past Due: How Medical Debt is Harming Americans and the Solutions We Need Now. Medical debt working group. Needham, MA: The Lown Institute, 2025.
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“We’re all here because this issue is a moral stain on the fabric of the country… We’re also here because if we want to fix this, we can," Dr. Vikas Saini told the crowd at the 2025 Lown conference on Medical Debt in America.
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Hospitals in 18 states own a total of $170 billion in assessed real property value and benefit from a total of $4.3 billion in real estate tax exemptions. However, this benefit is not spread out equally among states.
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The recently released study was conducted by the Boston-based Lown Institute, an independent healthcare think tank. The organization examined 1,800 nonprofit hospitals in 20 states, using average numbers from 2020, 2021 and 2022.
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These 20 hospitals avoided nearly $1 billion in property taxes.
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What types of initiatives are hospitals investing in to improve access to care and community health? We dug into the tax forms for some of the largest fair share surplus hospitals to find out.
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