Research Article
Huber GA, Roberts CA and James
Abstract
Background: Given the Affordable Care Act (ACA) implementation and the rapid transformation underway in the U.S. hospital system, it is important to take stock of the context in which governmental entities and nonprofit hospitals are meeting their shared responsibility for the public’s health. This article discusses key requirements for hospital tax exemption at the federal and state levels, and specifically discusses the responsibilities of nonprofit hospitals with regard to community benefit and to lessening the burdens of government. The emerging convergence of responsibilities presents a unique opportunity for government, hospital and community collaboration to improve public health in the U.S.Purposes: The purpose is to suggest the foundation and incentives for nonprofit hospitals and government to work more closely in addressing the public health needs of the populations they serve.Methodology/Approach: Our analysis focused on case law, statutory language and journal articles.Findings: As part of the ACA, an important policy objective of the Community Health Needs Assessment (CHNA) requirement for nonprofit hospitals is to encourage greater responsibility for public health into the nonprofit hospital sector. The CHNA requires input from the community and public health experts. Providing community benefit and lessening the burden of government are tax-exempt requirements in many states. The closer that nonprofit hospitals and local governments work together during the CHNA process, the greater the opportunities to tangibly improve public health, and at the same time reduce hospital risk of taxation at the local level.Practice implications: The sum of state and local tax exemption laws and regulations and the new CHNA federal requirements under the Affordable Care Act set the stage for a convergence of hospital government public health responsibilities. Therefore, for those states and communities interested in promoting and improving public health, the CHNA requirement of the ACA provides a unique opportunity for governmental entities to partner with their community hospitals to improve the public’s health.