"good" or "bad" is in the eye of the beholder.
The usual scheme for the poor is go to the ER. Get care, get bill, go bankrupt. Have hospital beg for uncompensated care reimbursement from the government. Taxpayers eventually pay or all the hospitals will go bankrupt. Pad the bills of those who can pay to make up for the losses.
Indigent care gets paid for by mostly local taxpayers and some Federal money. Expanded Medicaid is paid for at 100-90% by the Federal gov. So $$$ wise it makes no sense to reject the Federal money.
The scheme is even better. Charge uninsured person rack rate, settle for insured rate, write off difference as "charity" on the taxes.
Pharmaceutical companies get a tax write off for full retail price for the samples they give to doctors.