2/12 Almost 25% of nonprofit hospitals receive MORE in tax exemptions than they spend on ALL community benefits combined.

These aren't struggling institutions. Many reported record profits during the pandemic while simultaneously slashing charity care spending.

3/12 Hospital CEOs are paid millions in salaries and bonuses - compensation that often exceeds the total value of charity care their institutions provide.

The math is obscene: Executives profit more personally than hospitals spend helping patients who can't afford care.

4/12 In Texas, the game is rigged from the start.

Hospitals can count marketing budgets, community health fairs, and advertising as "charity care" - reducing pressure to provide actual financial assistance to patients who need it.

5/12 Here's how the scam works:

Step 1: Redefine "charity" to include marketing
Step 2: Use lobbyists to block reform bills
Step 3: Post charity care notices where patients won't see them
Step 4: Target vulnerable communities with aggressive collection

6/12 Real example: One woman had $2,200 garnished from her wages in two months for a $5,000 ER bill.

She qualified for free care under the hospital's own charity policy but was never told it existed.

This happens thousands of times across the country.

7/12 Geographic patterns reveal systematic targeting.

Research shows hospitals focus aggressive collection practices on areas with high Black, Latino, and immigrant populations while providing better charity care in affluent areas.

8/12 While Texas law protects wages from garnishment, hospitals can still freeze bank accounts and seize other assets through court orders.

Most patients facing lawsuits never show up to court because they can't afford legal representation.

9/12 During COVID-19, the hypocrisy became impossible to ignore.

Hospitals reported record financial surpluses in 2021-2022 while charity care spending fell as a percentage of revenue. Pandemic profits soared while patient assistance disappeared.

10/12 The industry's defense? "We follow all legal requirements."

Translation: We count marketing as charity, deploy lobbyists to block reform, and target the most vulnerable with collection tactics while taking billions in taxpayer subsidies.

11/12 Federal action is coming. The Consumer Financial Protection Bureau is exploring stripping medical debts from credit reporting.

But hospitals are lobbying hard to stall these protections, just like they've blocked state-level reforms.