Faith & Public Services
Mapping the $34.5 billion overlap between religious hospitals, federal social service grants, and the lobbying campaigns that protect the arrangement.
Published March 21, 2026
Key Findings
- Religious hospitals receive $34.5B annually in Medicare and Medicaid as the sole emergency room provider in 63 counties across 25 states (68 total including 5 hospital-only counties), covering 3,073,802 residents
- In 50 of those 68 desert counties (ER-only + hospital-only), the same religious organization (or its affiliate) also receives federal social service funding — creating a 'double capture' of public health infrastructure
- Religious organizations received $4.9B in direct federal grants (2015–2026), led by Catholic Charities' $3.9B for refugee resettlement, housing, and Head Start
- Federal lobbying by major religious health systems: $35.2M across 996 filings (2017–2025); top spenders include Ascension Health ($16.4M), CHA ($6.9M), and Trinity Health ($6.7M)
- New York SPARCS billing data confirms restriction: Catholic hospitals document zero tubal ligations in 47 percentage points more cases than secular peers (75% religious zero vs 28.2% secular) — even at hospitals performing 800+ C-sections annually
Religious hospitals, social service agencies, and family planning grantees receive tens of billions of dollars in annual public funding. In 63 counties, a religious organization operates the only emergency room (68 total including 5 hospital-only counties). In 50 of those counties, the same religious institutional network also receives direct federal grants for WIC, Head Start, refugee resettlement, or other social services — creating circumstances where families in those counties encounter only religiously operated providers across multiple publicly funded service categories.
The Hospital Desert
A “hospital desert” means the county’s only emergency room is operated by a religious organization that follows doctrine-based clinical guidelines, such as the Catholic Church’s Ethical and Religious Directives (ERDs). The ERDs prohibit sterilization, contraception, emergency contraception, and abortion at all facilities that operate under them.
New York state billing data (SPARCS) confirms these restrictions are reflected in actual care: Catholic hospitals document zero tubal ligations at a rate 46.8 percentage points higher than secular peers — 75% of religious hospitals record zero vs. 28.2% of secular peers — even at facilities performing 800+ C-sections annually.
The Double Capture
In counties where the only hospital is religious, low-income families often also encounter religious organizations when accessing federally funded services. Catholic Charities — the social service arm of the Catholic Church — received $3.9B in federal grants since 2015 for refugee resettlement, Head Start, housing, and nutrition programs (WIC). When the same diocesan authority governs both the hospital and the social service network, families may face no secular alternative within the county across multiple publicly funded service categories.
Lobbying
Religious health systems spent $35.2M in reported federal lobbying (2017-2025). The largest filers include Ascension Health ($16.4M), CHA ($6.9M), and Trinity Health ($6.7M). At the state level in New York, JCOPE records document 162 lobbying filings (2011-2025), including 54 related to certificate-of-need law — the regulatory framework that governs hospital closures and expansions.
Case Studies
Finney County, Kansas — Triple Capture
Finney County is the only “triple capture” county in the dataset. St. Catherine Hospital (Catholic, Diocese of Dodge City) is the sole ER for 38,000 residents in Garden City — a meatpacking hub with a large immigrant and refugee workforce. Catholic Charities of Southwest Kansas administers HUD housing and emergency services ($4.2M, USASpending). Head Start serves 272 children in the county.
A pregnant woman in Garden City delivers at a hospital that follows the Ethical and Religious Directives, receives food and housing assistance from Catholic Charities, and sends her children to a publicly funded Head Start — with no secular alternative at any point. Total Medicare and Medicaid revenue to the sole ER: $343M.
Clermont County, Ohio — Suburban Cincinnati
Clermont County (pop. 209,000) is the largest confirmed-Catholic sole-ER county in the dataset. Trinity Health’s Mercy Health - Clermont Hospital is the only emergency room, receiving $850M in Medicare and Medicaid revenue. This is a suburban county — not a remote rural community — where over 200,000 residents have no secular ER alternative.
Catholic Charities operates social services in Ohio ($8.3M statewide in AmeriCorps, HUD housing, and refugee resettlement).
Downloads
- Hospital desert counties (CSV) — all 63 ER-desert counties with funding, system, and denomination
- Double-capture counties (CSV) — 50 counties with hospital + social service overlap
- NY procedure gap — SPARCS (CSV) — facility-level procedure rates
- Federal lobbying filings (CSV) — by organization and issue code
For newsrooms: contact editor@thepublicledgers.org for the full dataset.
Explore Religious Healthcare Deserts
Counties where the only emergency room is operated by a religious health system. Filter by state or search by hospital name.