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Mayo Clinic CEO Dr. John Noseworthy, left. Photo: Evan Vucci/AP

Mayo Clinic CEO Dr. John Noseworthy ignited a firestorm this week after the Minneapolis Star Tribune reported that Noseworthy said the esteemed academic medical center would prioritize patients who have private health insurance over those who have Medicare and Medicaid for non-emergency procedures.

It was a damning statement — actively preferring people with better-paying coverage over the old and poor — but it reflected the unspoken policy of the hospital industry. Noseworthy also said this policy needed to happen so his not-for-profit organization "can be financially strong at the end of the year to continue to advance ... our mission."

We combed through eight years of the health system's financial documents to see if it was in peril. The gist: Mayo Clinic's finances are well above average.

Expand chart
Data: Mayo Clinic financial documents; Chart: Andrew Witherspoon/Axios

The numbers: Mayo Clinic's revenue has grown by more than 6% annually on average since 2009, reaching $11 billion in 2016 (making Mayo Clinic bigger than national companies like Hertz and Biogen). And more importantly, it is making a lot of money from its daily activities.

The changes Obamacare made to the health care system caused some fluctuation over the past eight years, but Mayo Clinic never had an operating margin below 4%. The margin was 8.5% in 2014, the first year of Obamacare's exchanges and Medicaid expansion.

Mayo's numbers are above the norm: The median operating margin for not-for-profit hospitals in 2015 was 3.4% and was lower in past years, according to Moody's Investors Service.

Patients with government insurance, especially Medicare, don't doom all hospitals. As health economist Austin Frakt has pointed out repeatedly, hospitals that lose money on Medicare often have dominant market power (like Mayo), charge higher private prices that are well above the fixed public rates, and are inefficient.

Mayo Clinic did not respond to questions about its financial documents and instead sent a statement that touted its uncompensated care. It also said commercially insured patients are needed to fund education and research for the future: "Balancing payer mix is complex and isn't unique to Mayo Clinic. It affects much of the industry, but it's often not talked about. That's why we feel it is important to talk transparently about these complex issues with our staff."

Go deeper

Why migrants are fleeing their homes for the U.S.

Illustration: Eniola Odetunde/Axios Photo: Herika Martinez /Getty Images 

Natural disasters in Central America, economic devastation, gang wars, political oppression, and a new administration are all driving the sharp rise in U.S.-Mexico border crossings — a budding crisis for President Biden.

Why it matters: Migration flows are complex and quickly politicized. Biden's policies are likely sending signals that are encouraging the surge — but that's only a small reason it's happening.

Cities' pandemic struggle to balance homelessness and public safety

Illustration: Sarah Grillo/Axios

Addressing homelessness has taken on new urgency in cities across the country over the past year, as officials grapple with a growing unhoused population and the need to preserve public safety during the coronavirus pandemic.

Why it matters: It’s led to tension when cities move in to clear encampments — often for health and safety reasons — causing some to rethink the role of law enforcement when interacting with people experiencing homelessness.

Biden to sign voting rights order to mark "Bloody Sunday" anniversary

President Biden will sign an executive order today, on the 56th anniversary of "Bloody Sunday," meant to promote voting rights, according to an administration official.

Why it matters: The executive order comes as Democrats face an uphill battle to pass a sweeping election bill meant, in part, to combat a growing number of proposals introduced by Republicans at the state level that would restrict voter access.