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UncategorizedBig hospitals get tax breaks for community benefits --...

Big hospitals get tax breaks for community benefits — but don’t earn them

Kaiser nurses strike over patient care -- as Kaiser shortchanges care for low-income people
Kaiser nurses strike over patient care — as Kaiser shortchanges care for low-income people

Editor’s note: As Kaiser nurses walk the picket lines (we will be reporting more on the strike later this week) it’s worth noting that these “nonprofit” hospitals aren’t all about the public good.

By Anna Challet

NOVEMBER 13, 2014 — Not-for-profit hospitals, like Kaiser in San Francisco, receive tax breaks in exchange for providing benefits to their communities — services like charity care for people who are uninsured. But are the not-for-profit hospitals in California providing enough of these services to earn their tax breaks?

Not by a long shot, according to a new study by The Greenlining Institute.

According to the study, not-for-profit hospitals in the state take in over twice as much money in tax breaks as they spend on community benefits. And an investigation into the community benefit spending of three large hospitals in San Francisco – Kaiser, St. Mary’s Medical Center and California Pacific Medical Center (CPMC) – revealed shoddy data reporting on where the money is going.

“It’s an unfair exchange. Hospitals receive about $3.2 billion in tax breaks because of their not-for-profit status, but from what we can see at the state level, there’s only about $1.4 billion going back into the community through their community benefits,” says Carla Saporta, Greenlining’s health policy director and one of the study’s authors. 

Additionally, hospitals are required to provide documentation that demonstrates how they’re spending their community benefit dollars, and the data is supposed to be publicly available. But when Greenlining tried to access that information, they found most of it to be incomplete or totally unclear.

“You can’t even really follow the money and understand how they’re really spending their community benefits dollars,” says Saporta.

Kaiser, for example, claims just over $24 million in community benefit spending, but accounts for less than $600,000 of that. Sutter Health’s five CPMC campuses claim over $167 million in community benefit, but Greenlining found the financial details to be largely inconsistent and incomplete.

Complicating the picture even more is the fact that costs aren’t standardized in hospital care. Different hospitals often charge vastly different amounts for the same services. For example, if you were a patient at Kaiser and a nurse gave you one generic Tylenol, you would be billed $19 for that pill. But at CPMC, you’d pay less than a dollar.

Because costs aren’t standardized, it becomes difficult to confirm how much charity care the hospitals are actually providing.

“Because they set their own pricing, when they’re claiming that a service costs a certain amount and claiming it as charity care or as a community benefit, it’s basically the hospital determining how much they’re truly spending to help underserved populations,” says Saporta. “When you have this arbitrary pricing, then it allows hospitals to actually pad their numbers.”

And it’s communities with higher numbers of people who are uninsured that pay the price.

“Certain communities, communities of color in particular and low-income communities, shoulder a higher burden of health inequities, of chronic illness,” says Saporta. Community benefit spending is meant to be one way of addressing those inequities, but a lack of transparency on the part of hospitals makes it difficult to tell if taxpayer dollars are going back into the community.

Greenlining recommends a legislative fix – the Medicare reimbursement rate, it says, should serve as the standard charge for any care that a hospital claims is a community benefit. And, critically, not-for-profit hospitals in California need more detailed requirements for reporting how they’re spending those dollars.

This article comes from New America Media.

Tim Redmond
Tim Redmond has been a political and investigative reporter in San Francisco for more than 30 years. He spent much of that time as executive editor of the Bay Guardian. He is the founder of 48hills.

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  33. meanwhile, how many millions of people have benefited from this law? and insurance costs are going down? if there is a political price to pay for this law, flawed as it may be, I think the human suffering alleviated is worth it. Dems just did a very shitty job at selling the relative success of the ACA. Buncha wussies, and they got what they deserved at the polls.

  34. In SciLaw we have found someone who knows his or her facts. Hooray! A breath of fresh air in the 48 Hills discussion threads.

  35. It’s funny how the currency of one of the major parties always goes up when the other holds the white house. You don’t see that phenomenon everywhere. No mystery, really. It’s because neither party really does the bidding of the people. The real puppeteers just play one off against the other, playing the public for fools.

  36. The Permanente Medical Group is the “for profit” part of Kaiser Permanente. — It must be difficult to separate what is non-profit, The Kaiser Foundation, from the “for profit,” The Permanente Medical Group.

  37. Obamacare came out in a format that conservatives originally wanted to preempt Hillarycare, with nothing to offer up to liberals.

    The ACA is the reason why the Democrats will not take the House until the redistricting post-2020 census. It contained the worst of all worlds, corporate welfare to alienate Democrats and interference in the market to antagonize Republicans. When you demoralize your base and antagonize your opponents you will lose the next election no matter how much you lecture your base on why this was all in their best interests.

    Had Obama run for office promising an individual mandate, President Romney would be in the middle of his second term under a strongly Democrat Congress.

  38. I wasn’t suggesting punishing the poor but punishing those who have broken the law by not buying mandatory insurance. By failing to buy that insurance they are pushing the expense of treating them onto the people who obey the law, and that should not be encouraged.

    While if you are poor then my understanding is that the government picks up some or all of the premia, so they have even less excuse for not buying insurance than those who have to pay for it out of their own pocket.

    We punish those who drive without motor insurance. I thought ObamaCare worked the same way. If it doesn’t, then it should.

  39. Greg, the possibility that you and I might actually agree on something is tantalizing. But even if we do agree on tax breaks, and we may, I suspect it is for different reasons.

    I don’t like tax breaks in principle because it is an attempt by the government to manipulate my behavior. In this case it is to motivate hospitals to dish out free care. But more generally there are tax breaks for buying a home, saving for retirement and a host of other supposedly worthy behaviors.

    I would greatly prefer that our tax system was neutral to behavior, and simpler, like a flat tax. Charge me a lower tax rate, take away the bribes and blackmail of deductions, and have a simpler tax system. That was the essence of Reagan’s tax simplification.

    My point about the tax breaks here being a waste was more to say to Tim that if the tax breaks are literally a dollar-for-dollar deal then they achieve nothing that could not be achieved by other means i.e. through direct subsidies to the poor. Maybe as some form of block grant.

    I’m also not sure where the $3 billion figure comes from. It is computed as the corporate taxes foregone compared to what a for-profit hospital would pay on the same numbers? That ignores the fact that the hospital might not opt to engage in loss-making lines of business if they were taxed on it.

    It’s possible that the hospitals claimed expenditure is exaggerated, but it’s also possible that the value of the tax breaks is as well.

  40. A. I agree with your take on tax breaks. There’s the additional benefit of having healthcare facilities spread out through various communities so that should be incorporated into any cost-benefit analysis.

    B. However, maybe you need to research Obamacare more before pontificating. First, people can opt out of the health insurance requirement and pay a penalty and second, there’s a long list of exemptions to the health insurance requirement including if your income is deemed too low. [I will not discuss the “charming” nature of a Republican wanting to prosecute the poor for failing to have the insurance and yet having no problems with a Republican Congress refusing to appropriately budget the SEC/EPA for white collar and environmental crimes.]

    C. Additionally, if you think Obamacare came out in a format that liberals originally wanted, you’re seriously delusional. Obamacare is hybrid legislation that incorporated a number of ideas from the 1993 Chafee bill and substantially similar to Romneycare.

  41. Absolutely, end the tax breaks. Tax breaks are designed to encourage companies to give back more than the cost of the tax break. If it’s less, then, as you say, what’s the point? Better to just have the government provide the services directly.

    And while Obamacare doesn’t eliminate the uninsured, there are a lot fewer of them now, so there’s even less need for tax breaks. Amazing that even the site’s resident troll agrees with this one.

    Of course he had to throw in a line about prosecuting the uninsured, even as he agrees with the premise of the article. But I guess we can chalk it up to a residual sadistic desire to hurt poor people. Because, as Wikipedia says, “trolling appears “to be an Internet manifestation of everyday sadism.” But hey, this is probably as close to agreement as we can expect.

  42. The premise of this story appears flawed. If the point of giving these hospitals 3 billion in tax breaks is that the exact same 3 billion gets spent on giving out free care, then there would be no point in giving them the tax breaks at all. The government might as well use that 3 billion to simply pay the bills for those patients and not give a tax break.

    The tax breaks are a quid pro quo for those hospitals’ willingness and ability to dish out free healthcare in the first place. And since demand for free healthcare is effectively unlimited, hospitals have to ration that care. Even SFGH rations care, not by turning people away, but by keeping patients waiting forever.

    There’s a much more interesting question here, however. Now that we have ObamaCare, it is illegal for anyone to not have healthcare insurance. So why are these hospitals still giving out masses of free healthcare? Why aren’t these patients being prosecuted for failing to buy insurance?

    Maybe the government should instead pick up the ObamaCare insurance premia for the very poorest in our community, and then not interfere with the ability of hospitals to charge market rates for care, which would be paid out of that insurance. We voted for ObamaCare (well I didn’t, but you know what I mean) so that everyone was covered and nobody slips through the cracks. That isn’t happening and free care is being given away, so of course hospitals need a bribe to do that. Blame Obama. I do.

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