Florida data show uninsured gunshot patients leave hospital sooner

Alea Bates was not ready to leave Tallahassee Memorial HealthCare’s main hospital four days after a stranger shot her seven times at close range. Hospital records showed that none of the bullets damaged her internal organs. Even so, after surgery, Bates said she could not get out of bed or walk to the bathroom without help. She described severe pain running down her left leg, weakness in her knee and a numb feeling below it, according to hospital records. Bates, who worked as an Uber Eats driver, said she did not have the strength to drive. Still, she said, the hospital told her it was time to go.

“They didn’t do any further X-rays or CTs or MRIs to figure out why my knee was numb,” she said. “And they were just like, you know, ‘It’ll go away.’” Bates said doctors told her she was medically stable. Because she did not have health insurance, she said, they could not send her to a rehabilitation hospital or skilled nursing facility, which can cost thousands of dollars a day. “They were just like, We need the bed for somebody who has insurance,” she said. “That’s of course, you know, what they say without saying it.”

At least one firearm injury is treated in an American emergency room every 30 minutes. Tens of thousands of people die from firearm injuries each year. Many more, including Bates, are left with long recoveries, medical debt and trauma that can last for years. How insurance affects the care of gunshot wound patients has long been unclear, but a new analysis by The Trace and KFF Health News examined Florida hospital data compiled to collect payments from insurers and filed with the state. The findings point to a pattern: Uninsured patients admitted to Florida hospitals with gunshot wounds spent significantly fewer days in the hospital on average than patients with insurance.

In some cases, the gap was about half the length of stay. Among the most severely injured patients, uninsured patients stayed three fewer days on average than insured patients. The data came from Florida hospitals and was obtained for this reporting with help from state law. The records did not identify patients by name. They did include insurance status, ZIP code, race and other demographic information. Reporters reviewed academic studies and government documents and spoke with health policy experts, doctors, activists and victims of gun violence or their relatives. The result is described as a first-of-its-kind look at what happens to insured and uninsured people who are shot and admitted for care.

The analysis reviewed hospital billing data from 2018 through 2024 obtained from the Florida Agency for Health Care Administration. It found that uninsured patients accounted for a quarter of the more than 20,000 gunshot wound hospitalizations identified, making them the largest single group treated for firearm injuries. On average, uninsured gunshot patients stayed about six days in the hospital. That was only three-quarters of the time spent by patients with private insurance and less than half the average stay for patients on traditional Medicaid, the public insurance program for poor and disabled people.

The pattern held across hospital size, location and ownership type. It also showed up at facilities that receive taxpayer money and are supposed to treat all patients regardless of ability to pay. The gap in hospital care did not disappear at hospitals with different business models or in different regions of the state.

The data also showed racial disparities. Nearly half of the gunshot wound patients were Black, meaning Black patients were heavily overrepresented. About a quarter of nonwhite patients were uninsured, compared with fewer than a fifth of white patients. The report says the inequality reflects a long history of discrimination in U.S. healthcare against Black and Latino patients, who are affected disproportionately by firearm violence and by lack of health insurance. The United States has more gun violence deaths than other wealthy nations, and Black Americans face the greatest burden. According to the Johns Hopkins Bloomberg School of Public Health, Black people are far more likely than white people to be victims of firearm homicide.

People who work in patient outreach say hospital staff may see gunshot victims as gang members or troublemakers who deserve blame for being shot. One study found that rehabilitation centers refuse to admit gunshot victims more often than other patients. Some hospital records also have included racist or insensitive descriptions of patients and their behavior. Leaving the hospital too soon after a traumatic injury can bring serious risks, including infection, hemorrhage, nerve damage and death, especially if wounds and mental health problems are not treated.

Arch Mainous, a University of Florida professor and vice chair for research in community health and family medicine, said there is evidence that financial incentives shape care for patients and hospitals. Even when teams are told to follow quality protocols, he said, “ultimately there’s a business aspect to it, whether the physician is thinking about it or not, whether the nurses think about it or not. But somebody is.”

The Florida findings come as Republican Gov. Ron DeSantis and state lawmakers have pushed to make guns cheaper and more widely available, even as Florida saw a 19% increase in gun deaths from 2014 to 2023. They also come as President Donald Trump’s administration has rolled back Biden-era efforts to curb gun violence and pushed millions of Americans off health insurance. Florida law allows eligible residents to carry a concealed firearm and to openly carry a firearm without a state-issued license. State law also blocks cities and counties from imposing stricter gun control measures. In early June, Florida Attorney General James Uthmeier asked a federal judge to strike down the state’s three-day waiting period for receiving a purchased gun, saying it was unconstitutional. The request is part of a proposed settlement in a lawsuit brought by the National Rifle Association.

KFF Health News and The Trace asked to interview administrators at nine large Florida hospital systems about why the disparities exist. None agreed to speak. Sarah Cannon, communications director at Tallahassee Memorial HealthCare, also declined to address Bates’ account. In an email, she said clinical decisions, including acute medical intervention, readiness for discharge and post-acute care needs, are guided by the patient’s condition and response to treatment. Cannon said the hospital provides support after discharge, including social workers who help arrange post-acute placement, home healthcare and primary or specialty follow-up.

Bates said she had to organize her own care after leaving the hospital. She said no one called to schedule a follow-up test of her leg’s muscle function, and her records show she did not receive one. “If I had had insurance,” she said, “they would have definitely kept me there for at least another week to work with me on my standing and walking.”

The analysis also found large differences at some of Florida’s biggest hospitals. At Jackson Memorial in Miami, uninsured patients stayed 6.6 days on average, compared with 10.7 days for privately insured patients and 15.4 days for patients on traditional Medicaid. Jackson Memorial did not respond to requests for comment. Tampa General Hospital reported average stays of 4.9 days for uninsured patients, 8 days for privately insured patients and 13.6 days for Medicaid patients. A hospital spokesperson said it was inaccurate to suggest that insurance status influences care decisions for trauma patients and said every patient is treated equally based on clinical need and urgency, not coverage. UF Health Jacksonville reported 7.2 days for uninsured patients, 8.5 days for privately insured patients and 13.8 days for traditional Medicaid patients. UF Health declined to comment. Broward Health in Fort Lauderdale reported 7.5 days for uninsured patients, 10.5 days for privately insured patients and 12.2 days for traditional Medicaid patients. A spokesperson said insurance status does not affect treatment plans and that physicians proceed in the patient’s best interest regardless of reimbursement or the length of stay required. Memorial Regional Hospital in Hollywood reported 6.7 days for uninsured patients, 8.8 days for privately insured patients and 9.5 days for patients on traditional Medicaid. The source text cuts off after that point.