Tag Archives: Affordable Care Act (ACA)

Some Political Issues around Health Should be Settling Now

Pearl River     Yes, we’re all tired of hearing about covid-19 and our powerlessness to protect ourselves, our federal government’s incompetence, our local government’s uncertainty, and the general chaos.  On the other hand, perhaps the virus this time is teaching that this is a parade without an end with many more to come.  If so, this national catastrophe may be moving to settle some contentious issues so that everyone’s voices are heard and the political issues resolved.

Take vaccines.  Remember there used to be anti-vac folks in huge pockets here and there.  Now, everyone from President Trump down to the school playground are pretending a vaccine for covid-19 is ready anywhere from in a minute in the president’s claim or as soon as possible in the public’s prayer.  Maine is a prime example.  A bill narrowly escaped their legislature that eliminated philosophical and religious objections to vaccinations in the state.  The approval had been on hard partisan lines with the Democrats voting to remove the exemption and the Republicans wanting to continue to allow them.  The division was supposedly so stark that an initiative made it to the ballot.  The vote on Super Tuesday, if you missed the headlines, was a beatdown.  73% of the voters and every single county supported the end of any exemptions for any reason to vaccinations.  Period.  End of argument.

How about sick leave?  A lot of talk, but not quite settled.  A new notion of emergency sick leave has entered the debate in the fog of war around the virus, even as others are coming to understand that paid sick leave is not a personal benefit, but a community and common good.  In Canada, 55% of a workers’ pay is being provided by the government for those forced to provide for their children with all day care centers closed.  Now that’s a plan.  Mandating paid sick leave without providing a way for it to be paid is a nonstarter.  Regardless of the rightness of paid leave, our social enterprise coffeehouses wouldn’t have any income to pay workers if we were forced to shut down.  We’re not alone.  The gig economy is defenseless.  We need a government and real leadership.  I read a headline that the virus is Trump’s Katrina.  Indeed!

Has this moved he needle finally on the Affordable Care Act and the need for a more comprehensive national healthcare system, even if not Medicare For All?  Maybe.  We’ll have to see.  Hospitals are strapped.  Tests are unavailable.  There finally may be an understanding that public health means health for everyone, not just private pay plans for the rich and luckily employed.

We may not have consensus on this, but people will be judging politicians on what they do and say about responding to the virus.  The fool Texas Congressman who claimed it was a hoax and then had to self-quarantine.  The President who said “what me worry?” and then watched the country implode in sickness and concern.   All will face the voters who might just have a different view now of what a community means and what its limits are without a real government ready to support all the people.   When the hero is an octogenarian public health and infectious disease expert and not the president, politicians are going to take notice and start paying attention in class or pay the price.

That’s my hope anyway.


Nonprofit Hospitals Are “Confused” About Charity and Profits

New Orleans       Over the last several years, ACORN International and the Labor Neighbor Research & Training Center have been collecting and analyzing the IRS 990 forms filed by tax exempt, nonprofit hospitals in Arkansas, Louisiana, and Texas.  This is a project driven by our “volunteer army,” so it has risen and fallen as our soldiers have entered or deserted the battlefield.  We have been immeasurably assisted though by student interns from Tulane University in New Orleans and the University of Ottawa in Ontario, Canada.  We collected most of the 990s three years to four years ago and are now collecting the most recent filings in order to compare the numbers and finish the report.

What are we looking for, you might correctly wonder?  We’re looking at the level of charity care, which is the essence of extremely valuable federal tax exemption enjoyed by these institutions.  Believe it or not, it’s not easy to find, and once found, is often abysmally small compared to what you would expect for institutions receiving the benefit.

A recent piece by Dr. Danielle Ofri in the New York Times noted that,

“An analysis by Politico found that since the full Affordable Care Act coverage expansion … revenue in the top seven nonprofit hospitals (as ranked by the U. S. News & World Report) increased by 15 percent, while charity care – the most tangible aspect of community benefit – decreased by 35 percent.”

This is a confounding observation which tracks the work we have been doing as well.  On one hand the “community benefit” is the test the IRS uses to determine whether a healthcare institution continues to be deserving of the tax benefit.  On the other hand, it flies in the face of the requirement in the Affordable Care Act that the IRS monitor and check charity care to assure that it increases under the ACA at penalty of pulling the tax exemption for non-compliant institutions.

Dr. Ofri  joins us in noting that some of these hospitals are also trying to claim a community benefit essentially by cooking the books.  In some cases, they are trying to write off the difference between their inflated sticker price for procedures with the more realistic, and lower, rate that Medicaid allows for a reimbursement by calling a “loss.”   Believe it or not!

When we began our work the average level of charity care around the country was roughly 4%.  Seems low, doesn’t it?  Nonetheless, we took that number as a comparative benchmark.  The giant Hermann Memorial in Houston was hardly half of that number.  The rapidly expanding billion dollar, Ochsner Hospital network based in New Orleans was hardly 1%.

We’re worried that the numbers are going down rather than up for charity care.  Iowa’s Republican Senator Church Grassley had insisted on this amendment to the Affordable Care Act.  Next year he will have served forty years in the Senate.  If charity care is going down, rather than up, we have to wonder if he’s still really on the job.