New Orleans    It took a long time before hard questions were asked of churches given the faith so many people have in them, but the process has produced important and powerful results.  Modern faith has created a priesthood of doctors and an altar of medicine where hospitals are their high churches.  Even as the Affordable Care Act is offering the promise of more accountability – and access – to care, it turns out according to a comprehensive report by the University of Maryland Baltimore County’s Hilltop Institute and their survey of state laws around the USA that state and local authorities in some places have forged the tools to require more accountability as well, having broken ground that other jurisdictions need to follow.

Here’s more good information that has come down from The Hilltop:

• Twenty-three states require nonprofit hospitals to provide community benefits.

The list includes California, Delaware, Florida, Illinois, Indiana, Maine, Maryland, Massachusetts, Mississippi (yes, Mississippi!), Montana, Nevada, New Hampshire, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, South Carolina (yes, South, not North), Texas (believe it or not!), Utah, Virginia, Washington, and even West Virginia.

• Nine states have broad and unconditional community benefit requirements in law or regulation.

That list includes California of course, but Florida is also in this number and needs to do a lot more with these tools and so do Montana and Nevada.  The rest are Indiana, Maryland, Maine, New Hampshire, and Washington.

• Six require non-profit hospitals to provide community benefits as a condition of certificate of need approval and three as a condition of hospital licensure.

The big six are Delaware, Massachusetts, Mississippi, stepping up again, New Hampshire, South Carolina and Virginia – that’s three in the south, none in the West or Midwest, if you’re keeping score.

The three that hold the licenses up for grabs are Massachusetts of course, New Mexico finally representing the West, and little Rhode Island, part of the Massachusetts slipstream.

There are also jurisdictions willing to use strong local handles to force accountability and community benefits.

• Six require community benefits as an express condition of property tax exemption.

These six are Illinois, Mississippi, Pennsylvania, Texas, Utah, and West Virginia, meaning that community groups and beleaguered patients, if able, could appeal a hospital’s highly valued multi-million dollar free ride on property tax for failing to provide adequate financial assistance, if you’re following my thinking here.

And, when the going gets tough, Illinois and Pennsylvania are willing to made hospitals pay sales taxes, and those are hefty, if the hospital doesn’t provide benefits to the community and New York and Ohio are willing to refuse any part of state reimbursements with their funds for charity care expenses if the hospital isn’t doing the job providing community benefits.

Let’s be realistic.  These are small steps towards accountability from private institutions receiving immensely valuable public benefits.It should be the least we should expect from all state and local jurisdictions, rather than an honor roll of the many and the few.

Our work in winning accountability from hospitals to our communities is cut out for us, but at least there are many that have been there and done that at least at the legislative level in creating the handles for us to make the work easier.

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JOHN LEE HOOKER & SANTANA – The Healer