A Prescription for Charity Care: How National Medical Debt Ills Can Be Alleviated by Integrating State Financial Assistance Policies into the Nonprofit Tax Exemption

Despite having the most expensive healthcare system in the world, the United States has been consistently ranked as having the worst system in terms of equity, efficiency, and healthcare outcomes among industrialized nations. The effects of these systemic issues are grounded in the patient experience as nearly forty-four percent of individuals have forgone recommended treatments and thirty-two percent have reported that they were unable to afford a prescription due to the high cost, according to a study conducted in 2018. Health is sacred, and financial circumstances should not determine the difference between treatment and illness, or life and death. “Financial assistance” or “Charity Care” programs provide free or discounted care for “appropriate hospital-based medical services” to individuals on a sliding scale. The Charity Care models of Washington and California provide invaluable support for low-income individuals who cannot afford healthcare and fall through the cracks of the Affordable Care Act (ACA). If several key components of the Washington and California Charity Care statutes become requirements for nonprofit hospitals to receive the federal tax exemption under § 501(r) of the Internal Revenue Code and related federal regulations, these critical safety nets can be expanded to provide protection for the most vulnerable healthcare consumers nationally