Non-profit hospitals are exempt from Federal, State, and Local taxes in exchange for providing care for all patients, regardless of ability to pay. Any excess funds must be reinvested into hospital facilities, staff, or satisfying an unmet health need in the community. This exemption is currently valued nationally at $28 Billion in 2020, with some estimates placing Texas hospitals receiving $1.7 Billion in annual exemptions. In return, non-profit hospitals spent more than $80 Billion in 2019 on medical services for low-income patients, building partnerships with local community organizations, and engaging in the social determinants of health (SDOH).

This report outlines the challenges to community benefit programming in Texas. Texans receive less than half the per capita spending than their national counterparts. Additionally, the little spent in the state is not targeted towards communities with the highest need. And finally, without Medicaid expansion, Texas hospitals are disproportionately spending on medical services and failing to address downstream drivers of health.