Big Health Systems Charge Triple the Medicare Rates for the Exact Same Care, Driving the Health Care Affordability Crisis - Families USA Skip to Main Content
05.07.2026 / Press Release

Big Health Systems Charge Triple the Medicare Rates for the Exact Same Care, Driving the Health Care Affordability Crisis

System-owned hospitals bring in nearly $28 million per year, per hospital, in profits on average, ten times more than rural independent hospitals

Last week, House Ways and Means committee members questioned some of the biggest health system CEOs about their profit margins, the CEOs offered no accountability.

WASHINGTON, D.C. – The biggest hospital systems in the country charge three times more than the Medicare rate for the same care, collect tens of millions in annual profits per hospital, according to a new analysis from Families USA released today. This report adds to decades of evidence showing a clear and disturbing trend: the more hospital chains consolidate, the higher prices Americans pay, in their premiums and their out-of-pocket costs.

The analysis found every state dominated by a handful of system-owned hospitals, which not only charged higher rates on average but also brought in nearly $28 million every year in profits per hospital, nearly ten times more than independent, unaffiliated hospitals that averaged roughly $3 million per year in net income.

“Our new report makes clear that big health systems are big business in America, at a big cost to all of us. Our health care affordability crisis is largely driven by the big corporate hospital systems leveraging their market power to charge egregiously high prices because they can,” said Sophia Tripoli, senior health policy director of Families USA and lead author of the report. “Over 182 million Americans with commercial coverage are charged on average nearly three times more than what Medicare pays for the exact same care resulting in higher premiums and out of pocket costs and lower take home pay for working people across the country. It is past time for Congress to hold these corporate health systems accountable for charging excessive prices. Every day that Congress fails to act is another day where Americans are forced to take on medical debt, delay retirement, and struggle to afford basic health care for themselves and their children – all while corporate health systems get bigger and rake in huge profits.”

Reviewing financial data of 2,800 hospitals across 49 states and Washington D.C. from 2018-2023, this report finds that a handful of corporate hospital systems in each state now control most of American hospital care. This analysis adds important data for policymakers to use in understanding hospital financials and strengthens the rationale and urgency for holding corporate health systems accountable for charging excessive prices that Americans increasingly cannot afford.

“This report reaffirms how Americans are trapped in a tale of two health systems. Policymakers allow big hospital chains to get bigger and to use their market power to charge commercial coverage up to four times Medicare rates. At the same time, Congress is cutting public programs meaning more uninsured and cuts to Medicaid disproportionately falling on the hospitals most in need, including independent, rural, and safety-net providers,” said Anthony Wright, executive director of Families USA. “Patients and consumers get the worst of both worlds — less coverage and services with ever increasing prices. We need Congress to cut costs, not care. We need to prevent predatory pricing policies of big hospital chains and not let them plead poverty as an excuse to overcharge patients without consequences from Congress.”

The Biggest Systems, in Highly Consolidated Markets, Charge the Most: 

  • HCA Healthcare (158 hospitals, 20 states): charged 339% of Medicare; $70.3 million in net income per hospital, per year
  • Tenet Healthcare (70 hospitals, 10 states): charged 312% of Medicare; $24.2 million in net income per hospital, per year
  • CommonSpirit Health, a non-profit (140 hospitals, 17 states): charged 306% of Medicare; $17.4 million in net income per hospital, per year
  • AdventHealth, a non-profit (38 hospitals, 8 states): charged 410% of Medicare; $38.4 million in net income per hospital, per year

Recent polling by Gallup found that voters across the political spectrum rank health care as a top concern, and in polling done by Families USA last year, 85% of voters across the political spectrum found fees and prices charged by hospitals unreasonable.

In the report, Families USA outlines immediate, short-term policy solutions that will address the problem of increased hospital consolidation and hold health care corporations accountable for excessive prices, including legislation that has gained traction recently like the Price Tags Act. Many of these policies have received bipartisan support from members of Congress and strong support among voters on both sides of the aisle when polled.

  • Mandate full price transparency across hospitals and health plans
  • Ban anticompetitive practices between hospital systems and insurers
  • Adopt site-neutral payments so the same care costs the same everywhere
  • Strengthen oversight of nonprofit hospitals to ensure real community benefit
  • Limit hospital prices or price growth relative to Medicare benchmarks

The analysis is available for download here. For more information on policy solutions to address the health care affordability crisis and rein in the corporate greed that is driving up health care costs, Families USA’s Affordability Agenda is available here.