A new Patients Rising report finds that in nearly half of the consumer bankruptcy filings we reviewed, the hospital owed money was a nonprofit participant in the federal 340B drug-discount program — the program meant to protect exactly these patients.

In a small town in Louisiana, a household living on $1,800 a month filed for bankruptcy owing $386,758 to a single hospital. Medical debt made up 98 percent of everything they owed. The hospital wrote the balance off when the case was discharged — as everyone surely knew it would. But first, the family had to go bankrupt.

That hospital participates in the federal 340B Drug Pricing Program, which gives "safety-net" hospitals steep discounts on outpatient drugs on the premise that the savings will help low-income patients. Over the past year, our team at Patients Rising set out to test that premise against the public record.

We reviewed roughly 900 consumer bankruptcy filings across six states — Virginia, Wisconsin, Washington, Colorado, Louisiana, and Maine — and tallied every medical creditor listed on every schedule. These are public records, and we have deliberately used no names. We asked one narrow question: when patients are pushed into bankruptcy carrying hospital debt, which hospitals appear as creditors, and how often?

The answer was consistent across very different states. Of the 903 filings we reviewed, 406 — 45 percent — listed verified debt to a nonprofit hospital participating in the 340B program, totaling more than $6.6 million. These aren't estimates. They're line items, entered under penalty of perjury, by families listing everything they owed.

The pattern held state by state. In Wisconsin, a single system appeared in nearly a third of all filings we reviewed. In Washington, one hospital family accounted for the majority of verified creditor lines. In Maine, one system carried roughly two-thirds of the state's verified 340B debt. And the record documented the transparency problem directly: in Colorado, dozens of filings named only a parent corporation — meaning the patient couldn't identify which hospital had billed them, and neither could we.

We want to be precise about what this does and doesn't show. We are not claiming that 340B participation causes any individual bankruptcy, and our report is explicit about its limits. What the data show is narrower and, we think, harder to dismiss: the same nonprofit hospitals collecting federal discounts meant for low-income patients appear, again and again, as creditors in those patients' bankruptcies — and no public reporting lets anyone see whether those discounts ever reached the patients as charity care.

"These families entered these numbers under penalty of perjury," said Terry Wilcox, co-founder and CEO of Patients Rising. "A safety net that shows up in nearly half of the medical bankruptcy files we reviewed isn't catching people — and the public deserves to see where the savings actually go. Our ask is narrow: disclosure, not demolition."

That's the heart of our Patients' Right to Know Campaign. The report calls for three commonsense reforms: define "340B patient" in federal law so the term finally has enforceable meaning; require standardized, audited public reporting that separates charity care actually delivered from bad-debt write-offs claimed as community benefit; and require point-of-care disclosure so patients know when they're being treated at a 340B hospital and how to apply for assistance.

The full white paper lays out the findings, the methodology behind them, and where the research goes next.

Medical Bankruptcy in America is a report of the Patients Rising Patients' Right to Know Campaign. For media inquiries, contact [name / email]. A methodology and data summary is available to member offices and media on request.