Now is the Time to Press Hospitals for Community Benefit Agreements

New Orleans       Community benefit agreements have increasingly become part of the conversation in cities throughout the country when it comes to major developments at the intersection of private interest and public authority, regulations, and landholding.  Few large cities under assault from major and minor sports interests to support stadium projects have not found themselves engaging in negotiations around community benefit agreements for example.  There are other opportunities though, as we discussed with Enid Eckstein on a recent Wade’s World radio interview that was triggered by her article in Shelterforce advocating for community benefit agreements with hospitals, particularly nonprofits.

Eckstein knows the healthcare industry well, both inside and out.  She was an officer in SEIU’s giant healthcare local, 1199, based in Boston, and more recently has been a researcher and advocate focusing on the role of hospitals and healthcare in communities.  The notion of community benefit agreements or CBAs has gained a lot of traction in Massachusetts in no small part, Eckstein argued, because of aggressive work by the Attorney General of the state in stepping up to regulate and codify the requirements under Massachusetts law that hospitals provide community benefits that were something other than developments of their own programs and self-interest, whether expanding a clinic or marketing their services.

Massachusetts is pathbreaking in this area, partially because they were a leader in providing mandatory health care in the state that was an inspiration for the Affordable Care Act.  The ACA also sets the stage for activity in this area because it requires that hospitals do a community assessment survey of health needs every three years, and mandates that the assessment integrate the community itself into the process.  The amendments offered by Senator Chuck Grassley (R-IA) put the Internal Revenue Service in this play because of his concern that nonprofit, tax exempt hospitals need to prove that they were providing charity care and if not, the IRS should pull their exemption.

The IRS has only recently begun enforcing some of the ACA regulations on penalties for smaller businesses not providing insurance for their workers, so it is unlikely that they are doing much in this area yet either.  Nonetheless, as Eckstein argues from the Massachusetts experience the opportunity is there for organizations of all shapes and sizes to start pushing hospitals to do right and do more.

And, why not?  One of the most compelling examples she offered in her Shelterforce piece occurred in Portland, Oregon, which like so many cities nationally, is facing an affordable housing crisis.  As part of a hospital CBA, $21 million was set aside by the hospital to build affordable housing and that leveraged almost $70 million for the project.

Now is the time to start pressing everywhere for hospitals to open up the doors to community organizations and others to be part of their required community assessment process.  Once in the door, we all need to press for real community benefit agreements while we have the opportunity.

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“Aspirational Agreements”

Lake Buckhorn, Ontario  Sometimes language is not your friend, but a head fake to turn you from hard reality to some soft slush in the swamp of misunderstanding and mirage.

Over and over again during the ACORN Canada staff retreat the term, “aspirational agreement,” came up in different contexts from the organization’s engagement with various government authorities and corporate executives they had been pushing in one campaign after another, despite the fact that the very term is a contradiction in concept. An aspiration is a hope and sometimes a prayer, a wish and a wannabe, a goal rather than a plan, and something in the clouds that may never find the ground. An agreement is a commitment, a contract, and a binding glue between parties, hopefully operating in good faith, that represents a purpose, a plan, and real consequences for success or failure. An “aspirational agreement” is really nothing at all. It’s a promise on the schoolyard with fingers crossed behind the back. How does anyone in authority ever say something like this without a blush, much less find anyone listening with anything other than rage?

Listening to the reports found this falsehood cropping up over and over when the discussion involved governmental or corporate commitments to developing affordable housing or living wages for example, but nowhere did it seem to populate the conversations more densely than when “community benefits” agreements were on the agenda. Community agreements are not easy to win, but they are critical in trying to hold the feet to the fire of both governments and private, corporate developers, who, frankly, are in the business of over promising and under delivering. Developers are always self-interested and specialize in building castles-in-the-sky to get permission in the clouds and then excuse their failure to deliver based on the facts on the ground. Governments over promise on the short term to maintain support through the next election and hope to outrun the future on the long term. All of which makes the ability of community and labor organizations to win clear community benefit agreements on new projects and proposals in as clear and committed terms as possible, especially when it comes to jobs, housing, wages, social services, parks, and other amenities that are critical to people every day regardless of the profit-and-loss statements to investors later or the election returns in the by and by.

Lake Buckhorn

In Canada, and the United States and other countries are little different, everyone in power seems to be adopting the language of community benefits while running away from true commitments and signed, binding documents as fast as possible. “Aspirational agreements” are the perfect term for deception and disingenuous double-speak signifying nothing.

We’re certainly not fooled, but the effort to deceive certainly makes our work harder and the campaigns more conflicted, since now we have to spend time, energy and resources pulling the crust off before we can get anywhere close to the heart of the matter.

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