Population Health and Tax-Exempt Hospitals: Putting the Community Back into the 'Community Benefit' Standard
Jessica Wilen Berg
Case Western Reserve University School of Law
August 1, 2009
Georgia Law Review, Winter 2010
Case Legal Studies Research Paper No. 08-22
Disputes about tax-exemption are occurring all over the country. The IRS and CBO are engaged in national studies of non-profit hospitals and community benefits. State governments are considering whether to legislate minimum amounts of charity care in exchange for tax-exemption. Congress is debating whether hospitals should remain a part of the non-profit sector at all. At the same time, uninsured individuals are suing hospitals for unfair billing and collection practices. Creative accounting and expansive definitions of "free" care have led to a variety of non-ideal practices by hospitals in order to balance their bottom line, while at the same time maintain tax-exempt status. This article argues that the longstanding focus on providing individual charity care to meet the community benefit standard for tax-exemption is misguided. Instead, I determine that there are conceptual and practical arguments for requiring hospitals to provide population or public health benefits. I offer a detailed analysis for implementing a new standard, and a framework for quantifying community benefit under that standard. The suggestions set forth should result in better, more expansive benefits for communities; clearer guidance for health care institutions and tax authorities; and fewer problematic incentives for tax-exempt hospitals attempting to meet their community benefit obligations.
Number of Pages in PDF File: 43
Keywords: Hospitals, Tax-exempt, Charity Care, Community Benefit
JEL Classification: K23, K32, K34working papers series
Date posted: August 22, 2008
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