Mayo Clinic, one of the country's top hospitals, is in the midst of controversy after its CEO said that the elite medical facility would prioritize the care of patients with private health insurance over those with Medicare and Medicaid.

The prioritization by the Rochester, MN-headquartered medical practice was recently revealed by the Minneapolis Star Tribune. And it has quickly drawn out some sharp critics—as well as sympathizers.

In a statement to the Minnesota Post Bulletin, Dr. Gerard Anderson, the director of the Johns Hopkins Center for Hospital Finance and Management, compared the prioritization to policies seen in developing countries. "This is what happens in many low-income countries. The health system is organized to give the most affluent preference in receiving health care,” he wrote.

Likewise, Minnesota Department of Human Services Commissioner Emily Piper, expressed surprise and concern by the statements of Mayo’s CEO, Dr. John Noseworthy. "Fundamentally, it's our expectation at DHS that Mayo Clinic will serve our enrollees in public programs on an equal standing with any other Minnesotan that walks in their door," she said. "We have a lot of questions for Mayo Clinic about how and if and through what process this directive from Dr. Noseworthy is being implemented across their health system."

Specifically, Noseworthy said in a video to Mayo employees late last year:

We’re asking… if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so… we can be financially strong at the end of the year.

In statements, Mayo has confirmed Noseworthy’s prioritization and added that about 50 percent of its patients are beneficiaries of government programs. "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."

Mayo can use its standing as a prestigious institution to negotiate higher prices with commercial insurance companies, but it can’t do the same with the government. As such, those with private insurance can bring more money to the hospital than patients with the same treatments on government programs. Under the ACA, the number of people covered by Medicare and Medicaid has expanded. However, the law also decreased the number of uninsured, which can be costly to hospitals.

In his speech, Noseworthy said that Mayo had reached a “tipping point” with a recent 3.7 percent surge in Medicaid patients. “If we don’t grow the commercially insured patients, we won’t have income at the end of the year to pay our staff, pay the pensions, and so on,” he said. “So we’re looking for a really mild or modest change of a couple percentage points to shift that balance.”

Nevertheless, the nonprofit still generated substantial profits in 2016: $475 million.

Other experts expressed sympathy with the hospital's perspective. Daniel Polsky, a health economist at the University of Pennsylvania, told STAT that Mayo shouldn't be chided for the blunt revelation. “I don’t think they should be shamed for saying it,” he said. “I think there should be some public discussion about whether elite systems such as Mayo should provide equal access to all payer types. I don’t know the answer to that, but it’s a reasonable debate.”