Do Nonprofit Hospitals in Nebraska Provide More Community Benefit after the Enactment of Affordable Care Act?
The Affordable Care Act (ACA) added several new requirements related to the community benefit that non-profit hospitals need to provide to maintain their tax exempt status. This study examined the effects of ACA on community benefit using data for 52 Nebraska non-profit general hospitals, children’s hospitals, and their satellite facilities in Nebraska from fiscal year 2009 to 2012. Primary data was extracted from Internal Revenue Service (IRS) 990 forms managed by GuideStar, an organization that hosts a financial database on the nonprofit sector. This study assessed the total amount of community benefit from 2009 to 2012 and examined the change of total community benefit before and after the enactment of ACA in 2010. For each year, we also analyzed the breakdown of total community benefit into eight categories: financial assistance at cost (commonly referred to as charity care); unreimbursed Medicaid; other unreimbursed means-tested government programs; subsidized health services; community health improvement services; health professional education; research; and cash and in-kind contribution. Our study found that the total reported community benefit from 2009 to 2012 were $361M, $403M, $437M, and $445M respectively (in 2009 dollars), each accounting for 7.7%, 8.7%, 9.1%, and 9.2% of the total expenses of these non-profit hospitals in Nebraska. While the total community benefit provided by Nebraska non-profit hospitals increased, the breakdown of the total community benefit didn’t change over years. The unreimbursed Medicaid (31%), charity care (23%), and cash and in-kind contributions (16%) were the top three categories, followed by subsidized health services in all four years. These results suggest that Nebraska non-profit hospitals provided more community benefit with the increasingly stringent requirement from ACA. However, additional information is needed to examine if the resources are allocated to the services that address the broader community health needs and the comparison to the lost tax revenue.
Public health or related public policy
Compare the total amount of community benefits provided by Nebraska nonprofit hospitals before and after the implementation of Affordable Care Act.
Analyze the breakdown of total community benefits into eight IRS categories before and after the implementation of Affordable Care Act.
Keyword(s): Affordable Care Act, Hospitals
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I am an Assistant Professor in Department of Health Services Research & Administration at University of Nebraska Medical Center. My Ph.D. is in health policy with a concentration in economics. I have extensive experience in conducting health services research and have presented my study results in several previous APHA annual meetings.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.