Document Type

Article

Publication Date

2024

Abstract

Non-profit hospitals have long been required to provide certain benefits to the community in which they reside in order to maintain tax-exempt status. The nature of these community benefits has evolved since the mid-twentieth century, but “charity care”—free or discounted care for patients who are unable to pay for it—is the quintessential hospital community benefit. Although the Patient Protection and Affordable Care Act of 2010 (ACA) extended eligibility for subsidized health coverage to many more people living in the United States, some noncitizens—including those without a valid immigration status—were excluded. As a result, this group is disproportionately likely to need financial assistance to afford health care because they lack insurance. However, some hospitals exclude noncitizens from eligibility for charity care because of their immigration status.

This Article explores the development of prohibitions against discrimination on the basis of immigration status in hospital charity care programs in certain states and the relative inaction by the majority of the states and the federal government. When non-profit hospitals exclude patients from charity care on the basis of immigration status, they contribute to health care inequity among noncitizens—the population in the United States least likely to have access to health care. These actions contravene the longstanding tradition of non-profit, taxexempt hospitals providing benefits to the community of people living in the geographic areas from which the hospitals draw their patients. Congress, state legislatures, and hospitals themselves are in a position to prohibit discrimination in charity care programs; failure to act further entrenches the exclusion of noncitizens from the threadbare health care “safety net” and perpetuates inequity in access to health care for noncitizens.

Publication Title

Houston Journal of Health Law and Policy

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