Reports look to put a number on hospitals' tax-break benefits
By Alex Kacik / September 26, 2024
Two recent reports attempt to put a number on the value of nonprofit hospitals' tax breaks.
As nonprofit health systems and hospitals grow, a smaller number of organizations account for a larger share of total tax exemptions, including income, sales and property tax. The dynamic has reinvigorated a debate on nonprofit hospitals’ tax-exempt status among industry groups and policymakers, along with other stakeholders.
The American Hospital Association commissioned a report published Tuesday that found nonprofit hospitals’ community benefit spending far outweighed the value of their federal tax exemptions in 2020.
Hospitals reported an estimated $129 billion in community benefits in 2020, compared with an estimated $13.2 billion in forgone federal revenue from tax exemptions, according to the analysis performed by accounting firm EY.
EY analyzed the Medicare hospital cost reports for 2,432 private, nonprofit non-specialty hospitals, comparing federal corporate income tax exemptions, tax-exempt bond financing and federal unemployment tax exemptions with nonprofit hospitals’ financial assistance offered to patients, community-building activities, the difference between reimbursement and the cost of care for Medicare beneficiaries and patients’ unpaid medical bills.
“Nonprofit hospitals have a special obligation to those they serve and this new analysis from EY shows these efforts are more than a worthy investment and that improving the health of their communities remains at the heart of the mission of the hospital field,” AHA President and CEO Rick Pollack said in a blog post accompanying the report.
A study published Thursday in the Journal of the American Medical Association, meanwhile, estimated nonprofit hospitals received $37.4 billion in tax benefits in 2021. About $13.8 billion of the benefits came from federal income tax, bond financing and federal unemployment tax exemptions. Roughly 7% of hospitals analyzed accounted for half of the total annual tax benefit, researchers from Texas Christian University and Johns Hopkins University found.
Researchers looked at the financial data of 2,927 nonfederal, short-term and specialty hospitals — specifically their federal and state income tax, sales tax, property tax and federal unemployment tax exemptions, tax-exempt bond financing and the fair market value of charitable donations.
The study authors did not calculate nonprofit hospitals’ community benefit spending, but they supported laws that would improve hospitals’ accountability to taxpayers.
"State and local governments should require nonprofit hospitals to disclose the value of their property tax and sales tax benefits," said Ge Bai, co-author of the study and accounting and health policy professor at Johns Hopkins.
Hospital supporters, including industry groups, have argued nonprofit institutions do a practically immeasurable amount of good for communities in the form of employment, free or discounted care known as charity care for low-income patients, necessary services, education and research, among many other benefits. Some policymakers and patient advocates counter hospitals should be offering more charity care for their communities and relaxing debt collection policies.
Last year, Oregon state legislators implemented a law requiring providers to make financial aid resources more accessible to patients and make any potential charity care deductions before sending patients a bill. Sen. Bernie Sanders (I-Vt.) in October issued a report finding 12 of the 16 largest health systems dedicated less than 2% of their total revenue to free or discounted care.