Report Finds More Care Is Going Unpaid at Wisconsin Hospitals
As health care costs rise, both charity care and bad debt has increased for hospitals.
Hospital waiting area. (Public Domain)
More than 2 million patient visits at Wisconsin hospitals last year involved unpaid care, according to an annual survey of Wisconsin hospitals.
The Wisconsin Hospital Association’s Uncompensated Health Care Report shows hospitals reported providing more than $2 billion in unpaid care in 2025.
It was nearly evenly split between charity care for patients unable to pay and bad debt, which represents bills hospitals have been unable to collect.
Last year’s total was 15 percent higher than in 2024, and represents about 2 percent of total patient charges for the year.
Kyle O’Brien, the association’s president and CEO, pointed out that the majority of the increase came in the form of charity care, which increased by nearly 29 percent from the previous year. The total amount of bad debt only increased by 4 percent from the 2024 level.
“As people have pressures in other parts of their life for expenses, whether it be housing or food or gas or whatever else, it may be more difficult for them to pay for other bills,” he said.
But O’Brien said the increase could also be the result of more coverage denials from private insurance companies, including those providing Medicare Advantage plans. If a provider already performed the surgery or other service and it’s denied by the insurance, it may end up categorized as charity care if the patient qualifies.
This not only affects a hospital’s operating margin, he said, but also its ability to invest in their staff and services.
Higher costs make paying medical bills out-of-reach
On a national level, it’s hard to know who is receiving the care that goes uncompensated. But Benjamin Vatter, assistant professor at the Massachusetts Institute of Technology who studies healthcare markets, said there are some clues.
“It tends to be younger people, a lot of working-age people,” Vatter said. “In states that did not expand Medicaid, it’s often the people that fall into these gaps that exist between (eligibility for ) Medicaid and the exchange’s subsidies.”
The exchange is the online marketplace established by the landmark 2010 Affordable Care Act, or Obamacare, where people can purchase private health insurance, often with federal subsidies.
Vatter said unpaid care can also come from people who are “underinsured,” whose insurance plans still leave them responsible for a large portion of their care.
With recent increases in health insurance premiums, along with most daily expenses, Vatter said it’s unsurprising that the amount of healthcare left unpaid has also gone up.
“If they don’t know or the hospital doesn’t give them the option to negotiate a discount, the only option that is left for them is just not to pay it at all,” he said.
But Vatter said that doesn’t mean that hospitals are bearing the cost of unpaid care alone. He pointed out that federal programs exist to reimburse hospitals for care provided to the uninsured. He said providing charity care is also part of why hospitals receive a sizeable tax exemption created for nonprofits.
Unpaid care expected to grow
Hospital leaders expect to end this year with an even larger amount of unpaid bills. The report shows total projected bad debt for 2026 is 18 percent higher than last year, while charity care is projected to increase 3.5 percent from 2025.
Bobby Peterson, executive director of public interest law firm ABC for Health, said this growing problem is something Wisconsin’s next governor will need to address.
But he said there are opportunities to get more of these bills paid by helping individuals find coverage and other assistance that they’re already eligible for.
“A proactive approach can really take out a lot of this so-called medical debt,” Peterson said. “Because there are payment sources — it’s just you’ve got to time it right. You’ve got to help people through the process. After all, they’re sick, they’re struggling and so they’re going to need help.”
The rise in uncompensated care also comes at the same time signups on the federal Health Insurance Marketplace have seen a slight decline.
A record high number of Wisconsinites signed up to have health insurance for 2025, according to data shared by the Wisconsin Office of the Commissioner of Insurance.
But enrollment was 7 percent lower for 2026, which the OCI press release attributed to “market destabilization driven by federal actions.”
Congress let an increase in premium tax credits from the COVID-19 pandemic expire at the end of 2025, effectively lowering the amount of assistance offered to help people afford the cost of their plan.
Last year’s One Big Beautiful Bill Act also made administrative changes to Medicaid, including a work requirement that goes into effect next year, which state health leaders have said could lead to coverage expiring for tens of thousands of Wisconsinites.
O’Brien said the WHA is concerned about administrative hurdles that can make it harder for eligible people to maintain coverage.
He urged people to reach out to their local hospital for help finding coverage and to pay attention to annual enrollment periods, including the current open enrollment for the Health Insurance Marketplace, which ends Dec. 15.
Report: More care is going unpaid at Wisconsin hospitals was originally published by Wisconsin Public Radio.
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