US hospitals are required by law to treat anyone who comes to them, regardless of their ability to pay. However, that mandate only extends to stabilizing the patient if there's a way to transfer him/her to a different facility. Take my wife, for example. She has excellent medical insurance, but the hospital closest to our house isn't in the network. If she got really sick, the ambulance would take her there (because it's the closest ER and that's the law), and they would have to treat her despite the fact that - as far as they're concerned - she is "uninsured." They would stabilize her and send her to the nearest hospital that does take her insurance.

Crazy, right? In actuality, I'm pretty sure that her insurance would pay the bill anyway (due to the medical necessity), but she can't make an appointment there unless she's willing to pay out of her own pocket.

In this case, I'd bet dollars-to-doughnuts that the fatty showed up at the ER with chest pains, and the hospital figured out what's wrong with him (heart disease related to his obesity). Since he's not in immediate danger, they can transfer him to a different facility if one is willing to take him, but that would have to be a place that takes charity cases. The also might be able to just discharge him with instructions, but that probably depends on the laws of the state he's in. In any case, he's going to need a very expensive surgical procedure in the near future, and the available organs apparently go to people who are not breaking the law to be here. He can go back to his home country and get the transplant there.