Hospitals are swimming in cash

Details: Axios analyzed the financial statements of 31 prominent not-for-profit hospital systems for the first 3 months of 2019.

• This sample collectively generated $68.5 billion of revenue in the first quarter of this year. That's $274 billion annualized, or more than one-fifth of all hospital spending.
• The combined operating margin was 5.1%, compared with 4.5% in the first quarter of 2018.
• The combined net margin (after factoring in investment income) was 16.4%, a large jump from 5.5% in 2018.
• These margins are on par with some pharmaceutical and medical device companies, and well above the margins for insurers and drug distributors.

Between the lines: Hospitals are feasting on bigger investment returns, boosted by the stock market's run, but they also are profiting more from commercial and public health insurer payments.

The intrigue: Not-for-profit hospitals don't pay taxes and don't have "shareholders" like publicly traded companies, so they are required to reinvest any surplus cash into their communities.

• But that money is often directed toward building new patient towers, other construction projects and executive pay instead of charity care or other forms of "community benefit."

Case in point: Newly opened patient towers at Banner Health's academic medical center campuses in Arizona cost $1 billion and "are expected to drive additional volume increases," Banner said in a memo last week to bondholders. Banner declined an interview request.

• "It's clear the hospital industry today continues to be driven by volume, which is where the big returns are," said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy. "Value-based [payment] approaches conflict with that."

Go deeper: Hospitals are making a fortune on Wall Street

• "After nearly a month of stonewalling, it appears clear that the President has chosen the path of defiance, obstruction, and cover-up," the letter reads.

The state of play: Several White House officials have told Axios' Alayna Treene that the administration has no plans of complying with the committees' demands for interviews or documents without a full House vote formally approving an impeachment inquiry.

The big picture: The Trump administration's initial refusal to turn over the whistleblower complaint on the president's interactions with Ukraine is what led House Speaker Nancy Pelosi to finally support a formal impeachment inquiry.

Go deeper: Trump letter dares Pelosi to hold vote on impeachment inquiry

• Johnson asked the Justice Department earlier this week to look into links between Ukraine and Hillary Clinton's 2016 presidential campaign. His letter questioned the narrative that Biden's actions in Ukraine had nothing to do with his son's connection.
• However, it was also discovered that he signed onto a 2016 letter that mirrored Biden's work to reform Ukraine's prosecutor general and judiciary.
• There is no evidence that Biden's reform work in Ukraine was to protect his son's business dealings, as the president and some of his allies allege, or that he committed any form of corruption.

The state of play: Sondland, a Trump political appointee who donated $1 million to the president's inaugural committee, denied that there was a quid pro quo between the Trump administration and Ukraine's government in a series of text messages that former Ukraine special envoy Kurt Volker provided to a group of House committees investigating the Trump-Ukraine matter.

• "I think it’s crazy to withhold security assistance for help with a political campaign," Bill Taylor, the top U.S. diplomat to Ukraine, texted Sondland.
• Sondland texted back: "Bill, I believe you are incorrect about President Trump's intentions. The President has been crystal clear no quid pro quo's of any kind."
• The New York Times reported that Sondland's response came only after he spoke to the president.

Go deeper: House committees release texts from former Ukraine envoy Kurt Volker