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The U.S. House Energy and Commerce Subcommittee on Health will hold an important hearing Wednesday entitled, “Lowering Health Care Costs for All Americans: Examining Policies to Increase Health Care Transparency.” This hearing comes at a critical moment, as Americans continue to struggle under the weight of rising healthcare costs and policymakers on both sides of the aisle are searching for answers.
The Trump administration and Republicans in Congress deserve credit for advancing transparency reforms throughout the healthcare system. Patients deserve to know what they are paying for, and employers deserve to understand where healthcare dollars are going. Taxpayers deserve accountability from every participant in the healthcare marketplace.
If Congress is serious about lowering healthcare costs, however, members must focus on one of the biggest sources of opacity and cost inflation in American healthcare: large nonprofit hospital systems that operate with many of the advantages of for-profit corporations while enjoying the substantial tax benefits reserved for charitable organizations.
Consider ECU Health in North Carolina. In March, a representative from ECU Health testified before House Energy and Commerce during a hearing examining the nation’s provider landscape. The financial picture surrounding the organization raises serious questions about whether current nonprofit hospital policies are serving patients or protecting powerful institutions.
According to publicly available financial information, the ECU Health system (which includes 9 academic and community hospitals, 13 surgery centers, and 220 primary care and specialty clinics) generated approximately $680 million in untaxed profits between 2021 and 2024, including roughly $280 million in untaxed profits in 2024 alone. During the same period, ECU Health reportedly received more than $300 million in tax exemptions. In 2024 alone, those exemptions were valued at more than $100 million, including approximately $60 million in foregone federal corporate income taxes and $7 million in foregone state taxes.
The ECU Health numbers are eclipsed by several other large, urban non-profit behemoth hospital systems in the U.S., like New York Presbyterian, which made a profit of more than $547 million in 2024 and the Cleveland Clinic, which made more than $1 billion ($1,078,933,223 to be exact, according to ProPublica).
Do these profits sound like they make sense for charitable nonprofit organizations to you?
There is nothing inherently wrong with earning profits. In fact, financial stability is important for any healthcare institution. Nearly half of America’s hospitals operate as for-profit entities and pay taxes accordingly. If a hospital system wishes to function as a profit-generating enterprise, that option already exists under U.S. law.
The problem arises when institutions receive enormous tax advantages intended for charities while accumulating hundreds of millions of dollars in surplus revenue with limited accountability regarding how those benefits are returned to the communities they serve.
This is not merely a question of fairness. It is a question of healthcare affordability.
Hospital costs remain one of the primary drivers of healthcare spending in America. Since 2000, hospital prices have increased by more than 280%, which is roughly three times the rate of inflation. Those costs ripple throughout the healthcare ecosystem. Higher hospital prices lead to higher insurance premiums, higher deductibles, higher employer healthcare expenses, and ultimately higher costs for American families.
In many ways, hospital pricing is the first domino. When hospital prices rise unchecked, the effects spread across the entire system.
That is why transparency matters. Congress should continue demanding clear reporting from hospital systems regarding pricing, executive compensation, charity care, community benefits, and the financial value of the tax exemptions they receive. Policymakers should also examine whether existing nonprofit standards adequately distinguish between organizations operating as true charitable institutions and those functioning more like large commercial enterprises.
Tax-exempt status should be earned, not assumed. It should come with meaningful obligations to patients, communities, and taxpayers.
Tomorrow’s Energy and Commerce hearing presents an opportunity to ask tough questions and pursue real solutions. Transparency alone will not solve every problem in healthcare, but it is an essential first step, as Americans cannot reform what they cannot see.
Members of Congress should keep up the pressure. They should follow the money, demand accountability, and focus particular attention on hospital costs that sit upstream from so many other healthcare expenses. Patients, employers, and taxpayers deserve a healthcare system that rewards value and service, not one that allows powerful institutions to hide behind nonprofit labels while generating hundreds of millions in untaxed profits.
The American people are paying the bill. They deserve answers.
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