One of the MAIN reasons that cost are out of control is all of the indigent care that's given and not subsidized by the Govt. Believe it or not, the vast amount of uninsured and illegal populous that overwhelm the system is staggering and hospitals and insurance companies bear the brunt of it with little to no Federal help. They then pass those losses on to the rest of the communities in the way of higher premiums and services.
There are hospitals that have had to close or privitize along the border becuase of the indigent care that was being given out.