The Patient Protection and Affordable Care Act (ACA), passed in 2010, is considered by many to be the most significant healthcare overhaul since the 1960s, but part of its promise — improvement of population health through requirements for non-profit hospitals to provide “community benefit” — has not been met. This paper examines the history of community benefit legislation, how community benefit dollars are allocated, and innovative practices by a few hospitals and communities that are addressing primarily non-medical factors that influence health such as social disadvantage, attitudes, beliefs, risk exposure, and social inequalities.
Get full access to this article
View all access options for this article.
References
1.
B.Obama, “United States Health Care Reform: Progress to Date and Next Steps,”JAMA316, no. 5 (2016): 525-532.
2.
S.Rosenbaum, “Additional Requirements for Charitable Hospitals: Final Rules on Community Health Needs Assessments and Financial Assistance,”Health Affairs Blog, January, 3, 2015, available at <https://www.healthaffairs.org/do/10.1377/hblog20150123.044073/full/> (last visited July 24, 2018).
3.
Internal Revenue Service, Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return; Final Rule, 79 Fed. Reg. 78956, December31, 2014.
B.I.Bittker and G.K.Rahdert, “The Exemption of Nonprofit Organizations from Federal Income Taxation,”Yale Law Journal85, no. 3 (1976): 299-358.
10.
A.I.Castro, “Overview of the Tax Treatment of Nonprofit Hospitals and Their For-Profit Subsidiaries: A Short-Sighted View Could Be Very Bad Medicine Comment,”Pace Law Review15, no. 2 (1995): 501-538.
11.
U.S. Department of the Treasury, Internal Revenue Service, Revenue Ruling 56-185, 1965-1 C.B. 202, 203, available at <https://www.irs.gov/pub/irs-tege/rr56-185.pdf> (last visited July 24, 2018). See generally M.Crossley, “Non-Profit Hospitals, Tax Exemption and Access for the Uninsured,”Pittsburgh Journal of Environmental and Public Health Law2 (2008): 53-59.
12.
U.S. Code § 170 (2013).
13.
S.Rosenbaumet.al., “The Value of the Nonprofit Hospital Tax Exemption Was $24.6 Billion in 2011,”Health Affairs34, no. 7 (2015): 1225-1233.
14.
J.James, “Nonprofit Hospitals’ Community Benefit Requirements,”Health Affairs Health Policy Brief, February25, 2016, DOI: 10.1377/hpb20160225.954803>.
15.
See Rosenbaum, supra note 2; James, supra note 14.
Id.; see also Laura ASpiceret al., “Hospital Community Benefits after the Aca: The Emerging Federal Framework,”Hilltop Institute (2011), available at <http://hdl.handle.net/10244/1011> (last visited July 23, 2018).
20.
See Davis, supra note 7.
21.
26 U.S.C.A. §501(r)(3)(B) (2010).
22.
M.Crossley, “Health and Taxes: Hospitals, Community Health and the IRS,”Yale Journal of Health Policy, Law, and Ethics16, no. 1 (2016): 51-110.
23.
Congressional Budget Office, Nonprofit Hospitals and the Provision of Community Benefits (Washington, D.C.: December2006), available at <https://www.cbo.gov/sites/default/files/109th-congress-2005-2006/reports/12-06-nonprofit.pdf> (last visited July 24, 2018); Government Accountability Office, Nonprofit Hospitals Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements (Washington, DC: September2008), available at <https://www.gao.gov/new.items/d08880.pdf> (last visited July 24, 2018).
See Crossley, supra note 22 at 64; U.S., Department of the Treasury, Internal Revenue Service, 2015 IRPAC Public Report, (Washington DC, 2015), available at <https://www.irs.gov/tax-professionals/2015-irpac-public-report> (last visted July 24, 2018).
County reports can be viewed at the website of the Illinois Department of Public Health, available at <https://iquery.illinois.gov/iquery/> (last visited July 24, 2018).
37.
S.L.Norriset.al., “Effectiveness of Self-Management Training in Type 2 Diabetes,”Diabetes Care24, no. 3 (2001): 561-587; M.L.Clark and S.W.Utz, “Social Determinants of Type 2 Diabetes and Health in the United States,”World Journal of Diabetes5, no. 3 (2014): 296-304.
38.
M.de Fátima Ferreira Grilloet al., “Effect of Different Types of Self-Management Education in Patients with Diabetes,”Revista da Associação Médica Brasileira (English Edition) 59, no. 4 (2013): 400-405.
39.
L.M.Gottliebet al., “A Systematic Review of Interventions on Patients' Social and Economic Needs,”American Journal of Preventive Medicine53, no. 5 (2017): 719-729.
40.
H.K.Seligmanet.al., “Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants,”The Journal of Nutrition140, no. 2 (2010): 304-310; E.Gucciardiet.al., “The Intersection between Food Insecurity and Diabetes: A Review,”Current Nutrition Reports3, no. 4 (2014): 324-332.
41.
A.V.Diez-Rouxet al., “Neighbourhood Differences in Diet: The Atherosclerosis Risk in Communities (ARIC) Study,”Journal of Epidemiology & Community Health53, no. 1 (1999): 55-63; See Health Research and Educational Trust, supra note 35.
42.
L.Prybilet.al., “Improving Community Health Through Hospital-Public Health Collaboration: Insights and Lessons Learned from Successful Partnerships,”Health Management and Policy Faculty Book Gallery2 (2014), available at <https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1001&context=hsm_book> (last visited July 24, 2018).
M.Exworthy, “Policy to Tackle the Social Determinants of Health: Using Conceptual Models to Understand the Policy Process,”Health Policy and Planning23, no. 5 (2008): 318-327.
45.
See Barnett, supra note 6.
46.
Community Health Roundtable, Better Housing for Healthier Children: A Report by the Community Health Roundtable, Springfield, Illinois, March2018, available at <http://files.sj-r.com/media/news/BetterHousing.pdf> (last visited July 24, 2018).
47.
See Barnett, supra note 6.
48.
G.J.Younget al., “Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA,”Health Affairs37, no. 1 (2018): 121-124.
49.
P. M.Lantzet al., “Health Policy Approaches To Population Health: The Limits Of Medicalization,”Health Affairs26, no. 5 (2007): 1253-1257.
50.
E.Hood, “Dwelling Disparities: How Poor Housing Leads to Poor Health,”Environmental Health Perspectives113, no. 5 (2005), doi:10.1289/ehp.113-a310.
