So yes, those who are least able to pay get charged the most. And many hospital systems adopt strict non-negotiation stances toward patients who are in financial difficulty. Unpaid bills are quickly turned over to collections agencies, written off as "free care", or sometimes the hospital will actually litigate to squeeze everything they can from patients already teetering on the edge of financial catastrophe.
And this concept of "free care" is where hospitals are suddenly very interested in the chargemaster. Those without insurance get charged the full monty. An inpatient stay that would normally net a hospital $1500 or so from a patient with Medicare will go on the books as a $100,000 bill for the uninsured patient. And this is the number that gets reported when it comes time for a non-profit hospital to tally its amount of charity care over the course of a fiscal year.
In all, the amount of charity care that the nation's non-profit, tax exempt health care organizations provide is of a magnitude of less than 5% of total operating revenue. When hospitals report their yearly contributions to "charity care", it's important to take the numbers with a grain of salt. However many millions in free care is claimed, be sure and knock off about 75-80% from the total; it's a number they would never have collected even 100% of their patient population having some form of insurance. It's a pure figment of imagination. Once again, as Brill notes:
In fact, when McKinsey, aided by a Bank of America survey, pulled together all hospital financial reports, it found that the 2,900 nonprofit hospitals across the country, which are exempt from income taxes, actually end up averaging higher operating profit margins than the 1,000 for-profit hospitals after the for-profits’ income-tax obligations are deducted. In health care, being nonprofit produces more profit.