Charity care at nonprofit hospitals
Nonprofit hospitals provide free and discounted care to patients who can't afford to pay, and in turn are exempt from most taxes. Each dot below is a U.S. nonprofit acute care or critical access hospital, placed by the charity care it reported to Medicare for 2023 and a rough estimate of the federal income tax it didn't owe that year.
Both axes are logarithmic: each gridline is ten times the one before. On the dashed line, charity care equals the estimated federal exemption. The shaded band along the bottom holds the hospitals with no positive net income in 2023, so no federal income tax to estimate (they still hold other exemptions); the band at left holds the that reported no charity care.
Charity care is highest where more people are uninsured
Median charity care as a share of total costs, for hospitals grouped by their county's uninsured rate.
About the data
Hospitals and finances. CMS Hospital Provider Cost Report (HCRIS), 2023 release: nonprofit (church or other voluntary) short-term acute care and critical access hospitals in the 50 states and DC, using each hospital's latest 2023 report. Charity care is the cost (not charges) of free and discounted care reported on Worksheet S-10. Bed counts are as reported on the cost report.
Tax exemption estimate. The vertical axis is a rough estimate of each hospital's federal income tax exemption: 21% (the federal corporate rate) of positive net income. It is a floor, not the full value of nonprofit status. It leaves out state and local property and sales tax exemptions (often the larger share), tax-exempt bond financing and deductible donations, so the full tax benefit sits higher than shown for most hospitals, including those in the bottom band. Cost-report net income also includes investment gains that swing from year to year. The Lown Institute publishes a fuller analysis built on IRS filings.
Charity care is one part of community benefit. Nonprofit hospitals also report other community benefit on IRS Form 990 Schedule H, including unreimbursed Medicaid costs, health professions education, research, subsidized services and community health programs. None of that is counted here, so charity care alone understates what many hospitals contribute.
Caveats. Charity care policies and reporting practices differ between hospitals and states, and states with broader Medicaid coverage tend to need less charity care. Hospitals in a larger system report separately here. Values below $10K are drawn at the edge of the axis. County uninsured rates are CDC/ATSDR Social Vulnerability Index 2022 estimates (American Community Survey 2018–2022), matched to each hospital's county from its Census-geocoded address.
Data and build script: github.com/usnish/usnish.github.io.