Gretchen Morgenson is the senior financial reporter in the Investigations unit at NBC News. Randy Slaughter, 36, experienced firsthand the escalating cost of healthcare in April 2024. After a three-day stay at Baylor Scott & White Medical Center in College Station, Texas, for severe abdominal pain, Slaughter was sent home without a diagnosis, advised to adjust his diet.

Unexpected Bills & Financial Strain

Despite having health insurance through his employer, Slaughter faced a substantial out-of-pocket expense due to a $10,000 deductible. His total hospital bill amounted to $33,393, leaving him with a $9,309 obligation. He arranged to pay this off in $150 monthly installments. “That $150 a month is a real kick in the shins,” Slaughter said.

A National Trend: Healthcare Costs Soaring

Hospital costs are a primary driver of increasing debt and inequality in the United States. According to Zack Cooper, associate professor of public health at Yale University, these costs have risen at a rate exceeding any other sector of the U.S. economy over the past two decades. Cooper stated that paying for hospital care is “the leading driver of health spending growth.”

Potential Coverage Losses

Experts predict the situation may worsen for many Americans. The Congressional Budget Office estimates that President Trump’s “One Big Beautiful Bill Act” could result in at least 10 million Americans losing health coverage by 2034. This is due to cuts to Medicaid and reduced eligibility for Affordable Care Act subsidies.

Billing Disputes & Resolution

Slaughter encountered difficulties managing his monthly payments and, upon requesting a lower amount, received a threat of collections from the hospital billing department, as documented in a recording reviewed by NBC News. He expressed frustration with the lack of accessible decision-makers and in-person communication options.

Following inquiries from NBC News, Baylor Scott & White erased Slaughter’s remaining balance of $4,431. Julie Smith, a hospital spokesperson, explained that she couldn’t discuss specifics due to a lack of signed authorization from Slaughter. However, she acknowledged the complexity of the billing process, particularly for emergency care, and stated that improving this experience is a priority.

Lack of Price Transparency

Federal rules implemented in 2021 require hospitals to publicly disclose pricing information. However, this information is often presented in a complex and difficult-to-understand format. An analysis of 3,236 hospitals revealed significant price variations for the same procedures.

Disparities in Pricing

OrbDoc, a healthcare technology company, analyzed hospital charges for uninsured patients compared to Medicare rates. Their findings showed that hospitals, on average, charge the uninsured almost five times what Medicare pays for the same procedure. Nevada hospitals charged the highest premium to Medicare payments (almost 12 times), while Maryland facilities charged the lowest (1.2 times). Texas hospitals charge nearly eight times Medicare’s pricing.

For-profit hospitals charge 8.7 times Medicare rates on average, while government-owned hospitals charge 4 times. State and local hospitals charge 4.5 times, and private nonprofit hospitals charge 5.4 times what Medicare pays.

The Impact on Insured Patients

Even insured patients experience higher costs through increased out-of-pocket expenses. Slaughter’s records show he was billed $1,486 for an emergency department visit, while Medicare pays $166.53. His out-of-pocket cost was $456, almost three times the Medicare rate. Abdus Muwwakkil, CEO of OrbDoc, stated, “If an insured patient needs forensic accounting to understand the bill, the system is broken.”

Factors Driving Up Costs

Experts attribute rising hospital costs to industry consolidation and anticompetitive mergers. Research co-authored by Yale’s Cooper found that hospital mergers between 2010 and 2015 raised prices by over 5%. Additionally, hospitals often make it difficult for patients to access and understand financial assistance programs.

Financial Assistance Challenges

Slaughter struggled to navigate Baylor Scott & White’s financial assistance program. Initially denied assistance, he later discovered he might qualify under a “medically indigent” category. After a nine-month process, his application was ultimately denied, citing income and deadline issues. After NBC News inquired, Slaughter received a refund of $1,167, combined with the previously removed balance, totaling almost $5,600.

While grateful for the outcome, Slaughter believes the hospital should proactively assist patients in determining their eligibility for financial assistance. “If they had told me in my hospital bed that I qualified, I would have immediately applied then and there,” he said. “Only after NBC News became involved was my case meaningfully addressed.”