💡 What’s Happening?
Anyone who comes into an emergency room in need of emergency care will be treated, but not everyone who does can afford the services they seek. In 2024, reporting Texas hospitals alleviated patients of about $7.4 billion through unreimbursed charity care and government-sponsored indigent healthcare – an endeavor which outranks most states’ efforts.
Charity care is a cornerstone of many hospitals’ missions, but it isn’t financially neutral. Every dollar spent providing uncompensated care must be absorbed within already-thin operating margins. At the same time, more patients are relying on hospitals’ requirements to provide treatment even if they can’t pay for care. As they bear inflationary costs, Texas hospitals remain the healthcare safety net for millions of Texans.
“‘Unfortunately, with this amount of uncompensated care and this amount of uninsured people, many people are using the emergency room as their primary care provider,’ Love said. ‘When someone presents in a very emergency situation at your emergency room, you have to render treatment. It’s the right thing to do. It’s the moral thing to do, and hospitals do it regardless of a patient’s ability to pay.’
Love said as people lose coverage and hospitals must accommodate, health care leaders may have to make difficult decisions about what facilities can offer.”
KERA News: North Texas hospitals provide billions in uncompensated care. ACA changes could increase that burden
“The Victoria County Health Department is stepping in to help address the high cost of health care. …‘The important part of this is trying to fill those gaps in health care and services for the community. We realize we need a safety net for the health department and to expand that safety net even further to help extend our services to those who may not have access to them,’ said Gonzales.”
Crossroads Today: Victoria County Health Department to launch Charity Care program to help residents receive needed care
📊 Texas-Sized Stats
- 5,000,000+ uninsured Texans, the highest rate in the country.
- 900,000 Texans who either cancelled or didn’t pay the first month premium for their ACA plans in early 2026, effectively losing coverage.
- Only 22.5% lower-income workers with employer coverage.
- $14.9B in total community benefits provided by nonprofit hospitals in Texas in 2024.
- Care provided at 162% above the charity care requirement, which commonly uses a 4% standard.
ℹ️ Charity in Context
More than five million Texans lack health insurance, and many more are effectively underinsured; patients covered on paper but unable to afford deductibles, premiums, copays or other out-of-pocket costs. Preventive care and health management are neglected, and many only seek urgent care for serious illnesses and injuries. For families, hospitals often become the healthcare safety net, providing financial assistance and essential services regardless of a patient’s ability to pay.
That role has never been more important – or more financially demanding.
Hospitals rely on reimbursement from Medicare, Medicaid, supplemental payment programs and commercial insurance to help sustain the services their communities depend on. But many of those revenue sources are under increasing pressure. Public programs frequently reimburse below the cost of care, while proposed and enacted funding reductions and continued cost growth further strain hospitals’ ability to absorb uncompensated care.
“When someone waits too long to seek medical treatment, a problem that was initially manageable can develop into a serious and expensive emergency. This is the reality for thousands of uninsured individuals in Texas who put off seeking health care due to cost. …Last fiscal year, [the center] obtained nearly $7 million worth of medication for their patients. …‘The vast majority of patients can actually have those medications directly shipped to their home. And when that takes place, we charge zero dollars. So they’re literally getting months of medications at a time, for no cost to them,’ Harwell said.”
KACU (Abilene NPR): Health care for the uninsured
“New federal limits on state-directed payments are set to cut Medicaid funding in most states. Hospitals are expected to bear the brunt since they account for the majority – 84%, around $78B a year – state-directed healthcare spends. The stakes are especially high for financially vulnerable hospitals, KFF notes, because these facilities are more likely to include safety net providers that primarily serve Medicaid enrollees. ‘Some hospitals could face pressure to close or reduce services,’ KFF underscores, ‘especially if uncompensated care increases because people lose Medicaid or coverage through the ACA (Obamacare) marketplaces.’”
HealthExec: Hospitals serving Medicaid patients prepare to take proposed payment caps on the chin
🏥 Load-Bearing Buildings
Texas hospitals will continue caring for anyone experiencing an emergency who comes through their ER, regardless of their ability to pay. But the strength of Texas’ healthcare safety net is inseparable from the financial health of the hospitals that provide it.
As more Texans struggle to afford coverage and rising out-of-pocket costs, demand for charity care continues to grow. Left unaddressed, those affordability challenges place increasing strain on the hospitals that provide emergency care, maternity services, trauma care, behavioral health and other essential services.
⭐ The data shows patients are increasingly relying on the availability of charity care, and Texas hospitals are doing more than enough. How can Texas ensure the healthcare safety net is protected as more families rely on it?
📖 Learn More
Unseen Savings: Charity Care, Community Benefit and the Safety Net
The Texas Standard: Champions of Charity Care
Charity Care and Community Benefit in Texas: Frequently Asked Questions
Nonprofit Charity Care and Community Benefit in Texas
